Sometimes you may have heard about a child who was born with some kind of heart problem when he was young. Perhaps that child had surgery at that time and the condition was corrected. But when such a child grows up a little, when he reaches a young age, the heart problem that existed in that childhood can resurface in a different way. In such a case, today we are going to talk about a very important treatment method that can give great strength to life.
So, what is TPVR?
Simply put, TPVR , or Transcatheter Pulmonary Valve Replacement , is a special procedure that replaces the malfunctioning pulmonary valve in your heart, but without opening your chest. This sounds amazing, doesn't it? Usually, when we think of replacing a heart valve, we think of open-heart surgery, which involves making a large incision in the middle of the chest. However, in this TPVR procedure, the surgeon makes a very small incision in the skin of your groin and performs the entire procedure through it.
The pulmonary valve is the gate that controls the passage of blood from our heart to our lungs. If it doesn't work properly, the blood flow to the whole body will be disrupted. So through this method, when you replace the malfunctioning valve with a new one, your life expectancy and quality of life will increase significantly. Also, it will help to delay or completely avoid the need for repeated major surgeries.
What actually happens with this TPVR treatment?
Consider that in traditional open-heart surgery, doctors cut open the chest bone and temporarily transfer the heart's function to a machine (heart-lung bypass machine), then remove the old valve and insert a new one. This takes a long time, takes longer to heal, and can be too risky for some patients to undergo such a major operation.
But the TPVR method is very different. It is a minimally invasive method. Here's what happens:
1. An interventional cardiologist makes a small incision in a major blood vessel in your groin (femoral vein) and inserts a thin, flexible tube, called a catheter, through it.
2. Inside this catheter is the new valve, a small balloon folded over.
3. Using special techniques such as X-rays, the doctor carefully guides this catheter through the blood vessel to the point where the pulmonary valve is located in the heart.
4. Once in place, the balloon is inflated. The new valve, which was folded, expands and snaps into place where the old valve was.
5. From that moment on, the new valve begins to function. Blood flow from the heart to the lungs is restored to normal.
One of the biggest advantages of this is that most people who have had this treatment can go home immediately. The recovery time is very short.
So, what happens if this pulmonary valve doesn't work properly?
There are two main problems that can occur with the pulmonary valve.
| Medical condition | Simply put... |
|---|---|
| Pulmonary Stenosis | Because the valve doesn't open properly, it reduces the amount of blood that can flow through it to the lungs. This puts a lot of strain on the right side of the heart, which can cause that part to fail. |
| Pulmonary regurgitation | Because the valve doesn't close properly, blood pumped to the lungs leaks back into the heart. This can put more strain on the heart and cause the right side to fail. |
Due to these two conditions, you may experience symptoms such as shortness of breath (dyspnea) , swelling of the legs and abdomen (edema) , chest pain , and irregular heartbeat . These symptoms will be greatly reduced after TPVR treatment.
Who is this treatment most suitable for?
If you were born with a congenital heart disease and had surgery for it as a child, there is a good chance that this treatment will suit you. Because the valve that was implanted in childhood (often a homograft) can deteriorate over time. Then the conditions mentioned above, such as stenosis or regurgitation, can appear in young adulthood. That is why doctors recommend the TPVR method for such people.
This procedure is used to treat the following congenital heart conditions:
- Tetralogy of Fallot: A combination of four defects, including holes in the heart, causing mixing of good and bad blood.
- Pulmonary Atresia: A condition in which the pulmonary valve is not formed at birth.
- Truncus Arteriosus: The two main blood vessels that originate from the heart (aorta and pulmonary artery) are connected together to form one.
- Transposition of the Great Arteries: The two major blood vessels are switched and connected on the wrong sides.
The most important thing is that your doctor will determine whether this treatment is right for you, based on your medical history, current health condition, and a number of special tests.
What happens before and after treatment?
Preparation before treatment
To see if you can do TPVR, your doctor will examine you carefully and may perform an exercise stress test. In addition, the following tests may be done:
- Angiogram
- Cardiac CT scan
- Heart MRI
- Echocardiogram
- ECG test
After considering all of this, the doctor will decide what the best solution is for you.
During treatment
You will be anesthetized before the treatment begins, so you will not feel any pain. The entire procedure takes about two to three hours. The doctors will insert the catheter, position the valve, check its function, and then remove the catheter.
After treatment
You will be kept in the hospital for observation overnight and will often be sent home the next day. You will be able to resume your normal activities in about a week.
What are the benefits and risks?
Like every medical treatment, this one has benefits and some risks.
| Advantages | Risks |
|---|---|
| The recovery time is short. | Blood clot. |
| The risk of infection is low. | Damage to blood vessels. |
| The hospital stay is shorter. | Irregular heartbeat (Arrhythmia). |
| There will be no major scars. | Heart infections (Endocarditis). |
| The pain is less. | Unexpected bleeding. |
Very rarely, serious complications such as heart attack, stroke, or death can occur. Therefore, it is essential to discuss the pros and cons of this treatment with your doctor before making a decision.
Some other important things to know
How long does a new valve last?
This depends on your overall health and the condition of your heart. Some people may need to have another surgery after a while. But the good news is that if necessary, you can have another valve replaced with the TPVR procedure.
Do you need to be careful during dental treatments?
Yes, this is very important. During things like tooth extractions and dental cleanings, bacteria in the mouth can get into the bloodstream and travel through it to cause a serious condition called endocarditis , an infection of the newly implanted heart valve. Therefore, before you have any dental treatment, you must definitely inform your dentist that you have had TPVR. You may be asked to take antibiotics before the treatment.
Are there any problems with airport security?
No. Airport X-rays and security checks will not harm you. However, if you are considering an MRI scan, talk to your doctor first.
Take-Home Message
- TPVR is a modern, minimally invasive treatment that replaces the heart's pulmonary valve through a small incision, without opening the chest.
- This is a good solution for valve problems that occur at a young age, especially for those who had surgery as children due to congenital heart disease.
- There is less recovery time, less hospital stay, and less pain than traditional open-heart surgery.
- As with all treatments, there are risks, so you should discuss this with your doctor before deciding whether it is right for you.
- It is very important for your well-being to follow your doctor's instructions exactly after treatment and to see your doctor on scheduled dates.
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