Russell Tenofsky already had undergone two open-heart surgeries for his congenital heart disease by age 50. But when his pulmonary heart valve began to deteriorate critically, Tenofsky found himself facing the daunting prospect of another major operation that could pose serious health risks.
心脏瓣膜置换术的温和方法
"The more frequently one has to open up the chest, the more scar tissue you get," says Dr. Elyse Foster, Tenofsky's cardiologist and director of 成人先天性心脏病 加州大学旧金山分校. And built-up scar tissue from multiple surgeries can make future operations more difficult.
幸运的是, Tenofsky's doctors 加州大学旧金山分校 found a less traumatic alternative to open heart surgery. He qualified for a "transcatheter" approach – a minimally invasive procedure that involves inserting a replacement valve through a vein.
特诺夫斯基生来就有 法洛四联症, a condition caused by a combination of four heart defects. Many people with TOF need surgery early in life and ongoing care to keep their hearts healthy.
In 1975, at age 8, Tenofsky underwent his first open-heart procedure 加州大学旧金山分校.
十大赌博平台排行榜 opened his chest again in 2009 to replace his pulmonary valve after a period of escalating symptoms like light-headedness and shortness of breath. The pulmonary valve is one of two that allow blood to leave the heart via the arteries.
"Over time, those replacement valves can deteriorate," Foster says. "The time is variable, but they last on average about 10 years."
When Tenofsky began having symptoms again in 2017, Foster wanted to explore alternatives to surgery. 所以她联系上了. Vaikom Mahadevan, a pioneer in the use of less invasive methods to treat adults with heart defects.
马哈德万来到 UCSF成人先天性心脏病诊所 in 2014 from the Manchester Royal Infirmary in the United Kingdom and is one of the world's few cardiologists to have used catheter-based approaches to replace valves in all four positions in the heart – aortic, 二尖瓣, 肺动脉和三尖瓣. He also led the team that performed the first 二尖瓣 valve replacement in a human using a catheter-based procedure.
"Essentially this is a big paradigm shift in the management of patients with valvular heart disease,马哈德万说. "It is transformational in the sense that for patients who have had multiple previous surgeries, every surgery becomes higher risk and recovery becomes slower."
Mahadevan estimates that avoiding subsequent surgeries can buy heart patients as many as 25 extra years of life. 幸运的是, the replacement valve from Tenofsky's 2009 surgery created a good landing zone for a new transcatheter pulmonic valve (TPV).
"Once you have a surgical valve, it's like valuable real estate inside it,马哈德万说. "We thought he would be a good candidate for what they call a valve-in-valve transcatheter procedure."
During the procedure, a TPV made from a cow's heart tissue is sewn into a stent. 十大赌博平台排行榜 then crimp the stent onto a balloon and insert it through an incision in the groin. The balloon is inflated, expanding the stent into the pulmonary wall. 当气球泄气时,支架会留在原位. In Tenofsky's case, the new valve was placed inside the one implanted during his previous surgery.
It takes doctors two to three hours to complete the procedure, 包括全身麻醉还是轻度镇静. 不像开胸手术, which can take several hours and requires hospitalization for about a week, patients who undergo TPV often go home the following day.
"I was a little sore and had some swelling and bruising that lasted about a month,特诺夫斯基说, who also had his cardioverter defibrillator replaced during the procedure because the battery was wearing down. 的去纤颤器, which his providers implanted about three months after the 2009 surgery, helps detect potentially life-threatening abnormal heart rhythms and restore a normal rhythm.
"I'm back to riding my bike trainer and doing all of the physical activities I did before my surgery,特诺夫斯基说. He went home one day after the procedure and was back to normal within weeks. "I had very few restrictions and am now fully recovered."
Adults with congenital heart disease benefit from ongoing care from specialized cardiac care centers such as the one 加州大学旧金山分校, 福斯特指出. Cardiologists who regularly treat patients with CHD have a much better understanding of the disease and potential complications – often leading to better outcomes, 她说.
"The continuity of care I receive from (my medical team) is imperative to my health,特诺夫斯基说, who volunteers for the Adult Congenital Heart Association. “我真的欠加州大学旧金山分校的十大赌博平台排行榜一条命."