Heart transplantation in valvular heart disease

Read this article to know about Heart transplantation in valvular heart disease.

In a patient with valvular disease does not require heart transplantation in normal course. There are other surgical and non surgical methods for their remedy like balloon valvuloplasty, valvotomy etc, but end stage valvular disease heart transplantation is inevitable.

Most patients because of their previous surgical intervention, have a higher hemorrhagic risk than primary in primary intention transplantations. Patients are under anicoagulant therapy which cannot be stopped or interuppted as in other surgeries. Though the risk is not to serious extent as there are many recent advances in surgical techniques and in managing hemostasis like aprotinine and biological glue.

How to select a donor for heart transplant

During selection of donor, standard rules to be followed like that of checking the same blood group and immunological and morphological identification should be maintained. If there is high pulmonary pressure and resistance, an oversized graft is suggested or a domino technique is to be done.

Some cases of valvular repair on the donor's heart prior to ngrafting has been described in the mitral and tricuspid position even in associated aortic valve replacement.

Technique of heart transplant in valvular disease

In valvular patients, the most opted technique is orthotopic transplantation. In this group , the alternative technique of transplantation with complete cardiectomy provides many advantages compared to the Shumway standard procedure. If right cavities is completely resected and left atrium size is rewduced, direct anastomosis of the superior and inferior vena cava can be performed.

This technique allows atrial rhythm disturbance occurance to be reduced as well as the thromboembolic risk starting at the left atrium. Right and left atrioventricular anatomy also prevents secondary occurance of mitral and tricuspid insufficiencies, which was seen in initial techniques.

Post operative course in heart transplantation

Post operative course is same as other transplantation. In fisrt week which is hemodynamic instability period pulmonary resistance monitoring is even more necessary for this group than for any other cause of heart transplantation. The immunosuppressive treatment should be done same as any other transplantation.

Reference: http://dr-health guide.blogspot.com

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