Cardiac valve reconstruction and replacement: a brief review.

Surgical methods for improving the function of diseased cardiac valves are valve reconstruction (valvuloplasty) and valve replacement with mechanical prostheses, biologic prostheses, or homograft (donor) valves. Reconstruction is used primarily for incompetent mitral and tricuspid valves and addresses each part of the valve apparatus individually. Annuloplasty rings are often used to restore the size and shape of the valve orifice. Long-term anticoagulation therapy is not necessary. The designs of mechanical prostheses have evolved since the early caged-ball prostheses. Current models are noted for their durability. Patients who undergo implantation of these prostheses must also undergo long-term anticoagulation therapy. Biologic prostheses made from porcine valves or bovine pericardium are not as durable as their mechanical counterparts, but they do not require long-term anticoagulation therapy. Homografts are used in relatively few centers. They have good hemodynamics and do not necessitate long-term anticoagulation therapy. Radiologists should be familiar with the radiographic appearance of the various valve prostheses and annuloplasty rings and with the advantages and disadvantages of their use in cardiac valvular surgery.