Name of the Procedure:

Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass. Also known as Pulmonary Valve Commissurotomy or Pulmonary Valvuloplasty.

Summary

Valvotomy is a surgical procedure to repair a narrowed pulmonary valve in the heart. The surgery involves opening the chest (open heart surgery) and using a heart-lung machine (cardiopulmonary bypass) to take over the function of the heart and lungs during the procedure.

Purpose

The procedure addresses pulmonary valve stenosis, a condition where the pulmonary valve is too narrow, restricting blood flow from the right ventricle to the lungs. The goal is to improve blood flow, reduce symptoms such as breathlessness and fatigue, and prevent further complications like heart failure.

Indications

• Severe pulmonary valve stenosis.
• Symptoms including shortness of breath, chest pain, or fainting spells.
• Poor oxygen levels in the blood.
• Heart failure or right ventricular hypertrophy (enlargement).

Preparation

• Fasting for 8-12 hours before the procedure.
• Adjusting or stopping certain medications as advised by the doctor.
• Undergoing diagnostic tests such as echocardiography, MRI, chest X-rays, blood tests, and electrocardiograms (EKGs).

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the chest to access the heart.
3. The heart is stopped, and a heart-lung machine is used to circulate blood and oxygen.
4. The surgeon makes a precise cut in the pulmonary valve to enlarge the opening.
5. The incision is closed, and the heart is restarted.
6. The chest is closed with sutures or staples.

Tools: Scalpel, retractors, cardiopulmonary bypass machine, sutures, and surgical instruments. Anesthesia: General anesthesia.

Duration

The procedure typically takes 2-4 hours.

Setting

Performed in a hospital operating room with facilities for open-heart surgery.

Personnel

• Cardiothoracic surgeons
• Anesthesiologists
• Surgical nurses
• Perfusionists (to operate the heart-lung machine)
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Arrhythmias (irregular heartbeats)
• Blood clots
• Stroke
• Heart attack
• Valve regurgitation or damage
• Complications from anesthesia

Benefits

• Improved blood flow from the right ventricle to the lungs.
• Reduced symptoms of pulmonary stenosis.
• Lower risk of heart failure and other complications.
• Improved quality of life and physical activity tolerance.

Recovery

• Initial recovery in the intensive care unit (ICU) for 1-2 days.
• Hospital stay of about 5-7 days.
• Gradual return to normal activities within 6-8 weeks.
• Follow-up appointments for echocardiograms and other assessments.
• Avoiding heavy lifting and strenuous activities for several weeks.
• Adherence to post-surgical care instructions including medication management and wound care.

Alternatives

• Balloon valvuloplasty: Less invasive, done via a catheter; suitable for less severe cases.
• Medical management: Medications to manage symptoms but not a definitive cure.
• Valve replacement surgery: Replacing the damaged valve; more invasive and used when repair isn't possible.

Patient Experience

• The patient will be under general anesthesia and will not feel pain during the procedure.
• Post-surgery, there may be pain and discomfort at the incision site, managed with pain medication.
• Discomfort from the breathing tube and chest tubes, if present.
• Feelings of fatigue during the initial recovery phase which improve over time.

Pain management: Analgesics and monitoring to ensure comfort throughout recovery.