وصف
Non-surgical therapies for valve repairs and replacements offer alternative options to traditional open-heart surgery for patients with heart valve disorders. TAVR is a minimally invasive procedure that involves replacing a narrowed aortic valve with a bioprosthetic valve via a catheter. It's often suitable for high-risk or inoperable patients. TMVR involves repairing a leaking mitral valve using catheter-based techniques like the MitraClip. It's an option for select patients with mitral regurgitation. Annuloplasty rings are used to reshape and support the mitral valve through minimally invasive approaches, preserving valve function .Artificial chords are inserted through minimally invasive procedures to correct mitral valve prolapse, improving valve function.
ملخص
- The discussion centered on non-surgical, percutaneous interventions for structural heart disease, particularly focusing on valve repair and replacement. Traditionally, open-heart surgery with large incisions and heart stoppage was the norm, but newer techniques offer alternatives for high-risk patients or those unsuitable for open surgery. The conversation highlighted the limitations of medications in treating structural valve modifications.
- Aortic valve replacement (TAVR) was discussed as a common non-surgical procedure performed via femoral artery access. The process involves crossing the aortic valve with wires and sheets, dilating with a balloon if necessary, and then deploying a balloon-expandable or self-expandable valve to replace the native valve. This approach is particularly valuable for patients with severe aortic stenosis.
- Mitral valve repair and replacement were also covered. Mitral regurgitation, caused by valve prolapse, can be addressed with mitral clips deployed through the femoral vein. This involves crossing the atrial septum and clipping the portion of the valve where leakage occurs. For mitral stenosis, balloon valvuloplasty can be performed to dilate the narrowed valve. Transesophageal echocardiography (TEE) is crucial for guiding clip placement and assessing leakage reduction.
- Newer valve technologies, such as the Navatar TAVR system, were presented. This valve features a naviseal cuff to prevent aortic regurgitation, a large cell design for coronary access, and a durable fabric material. These advancements aim for thinner profiles, easier coronary access, and improved long-term outcomes, particularly for younger patients potentially needing redo procedures in the future.
- The presenter shared personal experiences with successful mitral clip procedures on elderly patients with severe regurgitation, who experienced significant improvements in their quality of life. Emphasis was placed on the importance of physician awareness regarding the availability of these therapies, enabling them to identify and evaluate appropriate candidates who may not be suitable for traditional open-heart surgery. The speaker also mentioned a rare case of successful closure of pulmonary arteriovenous fistula.
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