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Cardiac surgery

  1. Valvuloplasty can be used in mitral or pulmonary stenosis (pliable, non-calcified valve, no regurgitation).
    A balloon catheter is inserted across the valve and inflated.
  2. Valvotomy Closed valvotomy is rarely performed now.
    Open valvotomy is performed under cardiopulmonary bypass through a median sternotomy.
  3. Valve replacements Mechanical valves may be of the ball-cage (Starr-Edwards Q), tilting disc (Björk-Shiley Q), or double tilting disc (St Jude) type Q.
    These valves are very durable but the risk of thromboembolism is high; patients require lifelong anticoagulation.
  4. Xenografts are made from porcine valves or pericardium. These valves are less durable and may require   replacement at 8-10yrs. Anticoagulations not required unless there is Af.
  5. Homografts are cadaveric valves. They are particularly useful in young patients and in the replacement of infected valves.  

Complications of prosthetic valves:

  1. Systemic embolism (in metallic valve)            
  2. Infective endocarditis
  3. Hemolysis                                        
  4. Structural valve failure        
  5. Arrhythmias.

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