This instrument is a unique heart retractor designed and proven specifically for heart valve surgery. It provides exceptional and consistent exposure of the right and left atrium, tricuspid and mitral valve for surgical repair or replacement, while reducing the need for surgical assistance. This retractor system provides the surgeon with the greatest visualization of the operative field.
Aortic valve replacement is more likely to require ongoing medication, but any one person’s post-operative medication will depend on that person’s condition and risk factors.
This may require a valve repair operation, known as a tricuspid annuloplasty, in which the valve is strengthened by the insertion of a ring around its periphery.
Both mechanical and bioprosthetic homograft (human) and allograft (animal) implanted valves will eventually need to be repaired or replaced.
The aortic valve and the mitral valve are the most commonly replaced valves. Pulmonary and tricuspid valve replacements are fairly uncommon in adults.
However, these patients will receive a replacement pulmonary valve, which will eventually wear out.
Risks associated with prosthetic valves include the development of valve-related endocarditis (valvular infection), the deterioration of bioprostheses (human or animal valves), embolism formation, and, in the case of mechanical valves, thrombosis may occur.
Before a valve or conduit replacement operation is attempted, the condition of the pulmonary and coronary arteries will need to be determined.
From the Dutch Congenital Corvitia (CONCOR) registry, we identified 20 patients with a biological or mechanical tricuspid valve prosthesis implanted between 1977 and 2012 (total of 31 prostheses).
To investigate the applicability of these results to a broader array of congenital heart disease patients, we report the long-term follow-up of prosthesis-related complications, including re-replacement of patients with a tricuspid valve prosthesis and congenital heart disease.
This study aimed to explore the incidence and the clinical presentation of tricuspid valve thrombosis occurring in bileaflet valves and to evaluate the diagnostic and the therapeutic approach.
Dr. Delos Cosgrove®, III has recently added two new angled, narrow, wire basket blades in addition to the original retractor blades for better surgical exposure. These angled blades are manufactured in a left and right design much like the Gillinov retractor blades for the Maze procedure. Unlike the Gillinov/Maze retractor blade, the Cosgrove® angled wire basket blades have a shallower depth for better mitral valve exposure (see side below).
Mitral valve repair can often provide a very normal life to the patient without the need for ongoing blood thinners and other modifications associated with valve replacements.
Unconventional sites are being used for pacing in patients with inaccessible right ventricle like single ventricle, atresia of tricuspid valve and in anomalous venous drainage. Here we report a case in which the right ventricle could not be accessed due to the metallic prosthesis. A 41-year-old lady required triple valve replacement for rheumatic involvement. Permanent pacemaker implantation was done with epicardial lead for bradycardia post operatively. Pulse generator change was needed within 3 years as the pacemaker reached end of life due to high lead threshold. Subsequent pacemaker implantation was done with a left ventricular lead in coronary sinus by percutaneous approach. One year after implantation, the threshold remains stable. Coronary sinus can be utilized for permanent pacing in patients with inaccessible right ventricle due to prosthetic tricuspid valve.
The procedure chosen will depend on the valve that needs replacement, the severity of symptoms and the risk of surgery. Some procedures may require long-term medication to guard against blood clots.
Trans venous right ventricular endocardial lead placement is the routine practice in clinical pacing. Inaccessibility of right ventricle mandates search for other sites in certain clinical situations. Epicardial pacemaker lead implantation is usually associated with development of high threshold and requires limited thoracotomy. Coronary sinus (CS) pacing was reported after Fontan operation, univentricular heart and in other conditions. There are reports of incidental placement of lead in coronary sinus due to anomalous venous drainage. Herre et al reported CS pacing in a patient with metallic prosthetic valve in tricuspid position. Organic tricuspid valve diseases requiring repair or replacement make the right ventricle inaccessible and tricuspid valve surgery often leads to heart block requiring permanent pacemaker implantation. Mechanical prosthesis in tricuspid position in our patient made the right ventricle inaccessible hence required lead placement in CS.
may also require a valve replacement. In this condition, the mitral valve allows oxygenated blood to flow backwards into the lungs instead of continuing through the heart as it should. People with this condition may experience shortness of breath, irregular heartbeats and chest pain.