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Doctors See ‘Revolution’ in Heart-Valve Surgery

January 20, 1993

MONTEREY, Calif. (AP) _ Ultrasound sensors placed directly on the beating heart have led to a ″quiet revolution″ in medicine, enabling many patients to have their heart valves repaired instead of replaced, a cardiologist says.

Heart valve surgery is performed on about 65,000 Americans each year, according to the American Heart Association. Most have their faulty valves replaced either with pigs’ valves or artificial valves. But valve repair is much safer than replacement, said Dr. Ann F. Bolger of Stanford University.

Bolger is one of the developers of the new ultrasound technique that allows doctors to see immediately whether repairs they have made to valves have indeed plugged all the leaks. ″Close doesn’t count,″ Bolger said.

The ultrasound devices are used during surgery, after the chest has been opened, she said. Sensors are placed directly on the heart to show the defects in the valves and the flow of blood leaking around them, she said.

Without ultrasound, surgeons have no way of adequately determining whether their repairs have been successful. The only alternative is to replace the valves.

Dr. William Spotnitz, a heart surgeon at the University of Virginia Health Science Center in Charlottesville, said the ultrasound imaging is ″an elegant technique″ that has had an important impact on heart valve surgery.

Bolger, who outlined the technique at a heart association conference of science writers, said repair is safer than replacement because replacement valves last only eight or 10 years before the patient needs surgery again.

Also, patients receiving replacement valves must take blood-thinning drugs for the rest of their lives, and the drugs pose a significant risk.

″I have a lot of people in my clinic who need a valve replacement,″ Bolger said. ″I need to give these people a better solution than valve replacement every eight to 10 years.″

Bolger said the technique is also allowing doctors to transplant human valves from cadavers more safely.

The human valves are frozen until ready to be used, and it takes 20 minutes for them to thaw, Bolger explained.

Using ultrasound images, surgeons can make necessary measurements of the heart while it is beating. They can then select an appropriately sized replacement and thaw it out before stopping the heart to do the operation.

Without ultrasound, the surgeons would have to stop the heart, measure it, and then keep the patient on a heart-lung machine for 20 minutes while the replacement thaws.

Every minute on the heart-lung machine increases the risk of problems, Bolger said.

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