Cardiosurgery: Tricuspid valve stenosis — Tricuspid valve replacement (artificial or biological). Treatment
Tricuspid stenosis (TS) is a variation of heart defects affecting the tricuspid valve and narrowing its holes. As a result of such deformation, the blood flow from the right atrium into the right ventricle is impeded and congestions in peripheral veins occur. Most often, the TS is combined with tricuspid insufficiency or stenosis of the heart valves. Isolated stenosis of the tricuspid valve is diagnosed in only 7% of cases. Typically, the TS is formed in the backdrop of rheumatic process.
Conservative Treatment of Tricuspid Stenosis
For some time, the TS can be compensated by a hard work of myocardium, pushing blood through the narrowed opening, but this condition is decompensated quickly. At the first signs of venous, the surgical correction of the defect is recommended to the patient.
In the course of preparation for surgery, the medical diet and conservative treatment is usually prescribed, which aims at improvement of the patient’s general condition, removal of stagnation and reduction of operative and postoperative risks. Depending on the clinical pattern, the following drugs are used:
- cardiac glycosides;
- venous vasodilators;
- antithrombotic agents;
- metabolic drugs;
- beta-adrenergic blockers.
Surgical Treatment of Tricuspid Stenosis
The surgery is preceded by a comprehensive examination, including an electrocardiogram, echocardiogram, X-ray, and cardiac catheterization subject to measurement of intracardiac pressure in various parts of the heart. The surgical treatment methods are selected individually, according to the degree of stenosis and combined heart disease. Most surgeries on the tricuspid valve are carried out using the cardiopulmonary bypass.
- Commissurotomy is dissection of the fused leaflets. When required, the physician excises calcification, deforming the valve and interfering in its work. Upon combined tricuspid stenosis and mitral valve stenosis, both defects are corrected simultaneously.
- Valve plastics is indicated for a combined defect, when it is combined with stenosis. Leaflet adhesions are dissected and the annulus is reinforced by sutures or support structure.
- The prosthetics is used only in the case of gross violations of the valve structure. The valve elements are excised and replaced with implanted prosthesis.
The postoperative prognosis depends on severity of stenosis and general condition of the patient. In European clinics, the long-term survival after surgery reaches 87%.Hide
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