Amanda’s surgery will be to repair her tricuspid valve. This valve is in the right side of the heart and separates the right atrium and the right ventricle. The valve keeps blood from flowing back into the right atrium. Amanda’s valve has what they call severe regurgitation. This is where the valve doesn’t close completely and allows blood to flow in the wrong direction. Amanda’s pacemaker is a dual chamber which means she has leads, pacemaker wires, in both her atrium and ventricle. The only way for a lead to get to the ventricle is through the tricuspid valve.
She has had several sets of leads removed and replaced due to infections and has had a lead running through her tricuspid valve for almost 10 years. This has caused damage to the leaflets on her valve thus causing it not to close properly.
The surgery will be a minimally invasive open heart. This is preferred to the traditional open chest surgery, which Amanda has had twice. Benefits of this type of surgery is a quicker return to normal activity, less soreness, less scarring, and less chance of infection. This surgery is done via a small 2 or 3 inch incision on the right side of the chest. A spreader is used to give access between the ribs.
This procedure is to repair the valve, but with the possibility of replacement if necessary. If replaced the valve will be a biologic valve, likely a pig valve, since pacemaker leads can’t go through a mechanical valve.
The approach the doctor will use is to leave the pacemaker lead on the outside of the valve. This should rid us of the trouble of the lead causing future damage to the newly repaired valve. This helped relieve one of my worries because the last time Amanda had her pacemaker and leads placed the doctor had a hard time finding good conduction due to scar tissue build up. Leaving the lead in place leaves no worry for placement problems. One of the downsides to this approach is the lead will have to be a permanent fixture in Amanda’s heart, never being able to be removed.
Although this surgery is new to us, surgeries in general are nothing new. As we say, we’ve become old hands at this hospital thing! Not something great to be a good hand at but none the less we are. This is a familiar hospital which will make things easier. Also our prior to surgery routines helps.
