Valve Replacements

On cardiac anesthesia, I commonly see aortic valve replacements for aortic stenosis. Aortic stenosis, narrowing of the gateway from the heart to the rest of the body, causes symptoms by limiting the heart's ability to pump blood adequately forward (like a clogged pipe). Repair or replacement of the valve can relieve the strain on the heart, eliminate symptoms, and extend the patient's life.

However, some valve disorders like aortic stenosis (as well as mitral regurgitation) have great anesthetic implications. So part of the challenge and learning in these cases is to anesthetize these patients without compromising the heart. The heart is often working as hard as it can for these patients, and there may be concurrent coronary disease as well. Anesthetics drop the blood pressure, and this can be catastrophic to the unprepared anesthesiologist.

Some of the surgeries I've seen are even more complicated like double valve replacements for aortic stenosis and mitral stenosis (a much rarer disease and difficult to approach surgically) and Partner trial cases, a clinical trial for surgical treatment of aortic stenosis. It's very educational seeing the range of simpler straightforward cases to the harder tertiary-care ones.

Prosthetic heart valves shown under GNU Free Documentation License, from Wikipedia.