Cardiology

Mitral Valve Surgery Treatment

Mitral Valve Replacement

Your mitral valve controls the flow of blood into the main pumping chamber (left ventricle) of your heart (see figure 1). Mitral valve disease is where the valve does not open properly or is narrowed, or does not close properly. This causes pressure on the heart and lungs, causing symptoms of palpitations, breathlessness and dizziness.

What is mitral valve Surgery?

Mitral valve surgery is a kind of surgery for either repairing or replacing the mitral valve in the heart. Blood flows from the lungs and enters a pumping chamber of the heart known 
as the left atrium. The blood afterwards flows into the final pumping chamber of the heart called the left ventricle. The mitral valve is present in between these two chambers. It 
makes sure that the blood keep on moving forward throughout the heart. The surgery may take two to four hours. This surgery can sometimes be done via a groin artery, with no cuts on 
the chest. The doctor sends a catheter with a balloon attached at the end. The balloon gets inflated and stretch the opening of the valve. This procedure is known as percutaneous 
valvuloplasty and is done for a blocked mitral valve. A new procedure involves inserting a catheter though an artery in the groin and clipping the valve to prevent the valve from 
leaking.

Why this surgery is Performed?Page Image

You may need surgery if your mitral valve is not working properly, because:
• Mitral regurgitation: When mitral valve does not close all the way and allow blood to leak back into the left atria.
• Mitral stenosis: When mitral valve does not open fully and restricts the blood flow.
• Valve has developed an infection (infectious endocarditis).
• Severe mitral valve prolapse that can not be controlled with medicine.

Minimally invasive surgery can be done for these reasons:
• Changes in mitral valve causes major heart symptoms, such as shortness of breath, leg swelling, or heart failure.
• Tests show that the changes in the mitral valve begins to harm your heart function.
• Damage to the heart valve from infection (endocarditis).

A minimally invasive procedure has a lot of benefits. There is less pain, blood loss, as well as risk of infection. Faster recovery than Open Heart Surgery. 
However, some people are not able to have this type of procedure.

 
What is mitral valve disease?

The mitral valve controls the flow of blood into the main pumping chamber or left ventricle of the heart. Mitral valve disease is when the valve does not open properly or is 
narrowed, or does not close properly. This may cause pressure on the heart and lungs, causing symptoms of palpitations, breathlessness and dizziness. In mitral valve disease, the 
mitral valve, which is present between your left heart chambers (left atrium and left ventricle), doesn't work properly.

Types of mitral valve disease:
Mitral valve regurgitation
In this condition, the flaps or leaflets of the mitral valve don't close tightly, causing blood to leak backward into the left atrium of your heart. If not treated, it may result in 
heart muscle damage.

Mitral valve stenosis
In this condition, the flaps of the mitral valve gets thick or stiff, and they may fuse together, thus resulting in a narrowed valve opening and reduced blood flow from the left 
atrium to the left ventricle.

Symptoms
Some people with mitral valve disease may not experience symptoms for many years. Signs and symptoms of mitral valve disease includes:
• Abnormal heart sound is heard through a stethoscope.
• Fatigue.
• Shortness of breath, particularly when you a person is very active or when he/she lie down.
• Swelling of one's ankles and feet.
• Irregular heartbeat.


What does the operation involve?

The operation is performed under a general anaesthetic and in general takes between three to four hours. Your surgeon will usually make a cut down the front of the chest, through 
your breastbone. Sometimes the surgeon may even perform the operation through a small cut on the right side of the chest and will be connected to a heart-lung machine, which allows the heart to be still while the surgeon replaces or repairs the valve. An incision is made in the left atrium to expose the mitral valve. The valve is replaced with either a 
biological or mechanical valve. The left artium is closed. After this surgery, patients are typically referred to an intensive care unit (ICU).
There are primarily two types of artificial mitral valves: mechanical valves and bioprosthetic tissue valves. The mechanical valves are made from metal and pyrolytic 
carbon, and can even last a lifetime. Patients with mechanical valves should take blood-thinning medications to prevent the clotting. Bioprosthetic valves or biological valves are 
made from animal tissues. Using these biological valves, patients can avoid blood thinners. However, the bioprosthetic valves only lasts 10 to 15 years. The choice of which valve 
type to use depends upon patient's age, medical condition, preferences with medication, as well as lifestyle. 

What complications can happen?

• Blood clots in the legs that can travel to the lungs.
• Blood loss.
• Breathing issues.
• Infection, including inside the lungs, kidneys, bladder, chest, or heart valves.
• Reactions to medicines.

Minimally invasive surgery techniques have very less risks than an open surgery. Possible risks from minimally invasive valve surgery are:
• Damage to other organs, nerves, or bones.
• Heart attack, stroke, or death.
• Infection to the new valve.
• Irregular heartbeat that should be treated with medicines or a pacemaker.
• Kidney failure.
• Poor healing of wounds.

Are there any alternatives to surgery?

Medications such as diuretics, ACE-inhibitors and digoxin are the principal alternatives to this surgery.
Diuretics, also known as water pills, are the medications mainly designed to increase the amount of water and salt expelled from the body as urine.
An angiotensin-converting-enzyme inhibitor is a kind of pharmaceutical drug used primarily for the treatment of hypertension and congestive heart failure.
Digoxin, sold under the brand name Lanoxin among others, is a medication used to treat various heart conditions. Mostly it is used for atrial fibrillation, atrial flutter, 
and heart failure. 

How soon will I recover?

After the operation you will be transferred to the cardiac intensive-care unit or high-dependency unit for a few days, and then to the ward. You should be able to go home after 7 to 
10 days. The healthcare team will tell you when you will be able to return to normal activities. Regular exercises can help to return to normal activities as soon as possible. Most 
people can make a good recovery, with no more shortness of breath or chest pain. You can have more energy after you gets recovered.

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