Name of the Procedure:

Resection or Incision of Subvalvular Tissue for Discrete Subvalvular Aortic Stenosis

Summary

This is a heart surgery that involves removing or cutting a part of the tissue below the aortic valve to relieve obstruction in blood flow. This procedure is aimed at treating a condition where the aortic valve opening is narrowed due to the presence of extra tissue below the valve, leading to improved heart function.

Purpose

The procedure addresses discrete subvalvular aortic stenosis, a condition where extra tissue below the aortic valve narrows the valve opening, obstructing blood flow from the heart to the rest of the body. The goal is to improve blood flow, reduce heart strain, and alleviate symptoms such as chest pain, shortness of breath, and fainting.

Indications

• Symptoms including chest pain, fainting, shortness of breath, or fatigue upon exertion.
• Echocardiogram or other diagnostic tests showing a significant obstruction below the aortic valve.
• Patients experiencing severe obstruction or at risk for complications if left untreated.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to medications, particularly blood thinners.
• Pre-operative diagnostic tests such as echocardiography, electrocardiogram (EKG), and blood tests.

Procedure Description

1. Anesthesia: The patient will be given general anesthesia to ensure they are asleep and pain-free during the surgery.
2. Incision: A surgeon makes an incision in the chest to access the heart.
3. By-pass: Typically, a heart-lung machine is used to take over the heart's pumping action.
4. Resection or Incision: The surgeon locates the subvalvular tissue causing the obstruction and carefully removes or cuts it.
5. Closure: The incision in the heart is sutured, and the chest is closed.

Tools used include surgical scalpels, scissors, sutures, and sometimes specialized imaging equipment.

Duration

The procedure usually takes around 3-4 hours.

Setting

This procedure is performed in a hospital operating room with intensive post-operative care facilities.

Personnel

• Cardiac surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Perfusionist (if heart-lung machine is used)

Risks and Complications

• Common risks: Infection, bleeding, arrhythmias, reaction to anesthesia.
• Rare complications: Stroke, heart attack, damage to the aortic valve or nearby structures, need for valve replacement.

Benefits

• Improved blood flow from the heart.
• Reduction in symptoms like chest pain and shortness of breath.
• Enhanced quality of life and reduced risk of heart failure.
• Benefits can be realized within weeks after recovery.

Recovery

• Hospital stay of about 5-7 days.
• Pain management with prescribed medications.
• Gradual resumption of normal activities over 6-8 weeks.
• Follow-up appointments for monitoring heart function and healing.

Alternatives

• Medication management to control symptoms (though not as effective for severe cases).
• Balloon valvuloplasty (less invasive but might not provide a permanent solution).
• Valve replacement surgery (if the obstruction is caused by valve damage).

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, they might experience pain and discomfort at the incision site, which will be managed with pain relief medications. Full recovery takes several weeks, during which time they may need to limit physical activity and attend follow-up visits to monitor their progress.