Mitral Valve Replacement

What is mitral valve replacement?

Mitral valve repair is an open heart procedure to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. This surgery is performed by Cardiothoracic Surgeons.

What is mitral valve ? And how it works ?

The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it takes in oxygen into the left atrium. When it opens, the mitral valve allows blood to flow from the left atrium to the heart's main pump chamber known as the left ventricle. It then closes in to keep blood from leaking into the lungs back when the ventricle contracts (retracts) to push blood out to the body parts. It has two leaflets like structure.

When does one need Mitral Valve surgery ?

One may need surgery if the mitral valve does not work properly because :

Mitral regurgitation -- A mitral valve that does not close at times and allows blood to leak back into the left atria.

Mitral stenosis -- a mitral valve that does not open fully to its ability and restricts blood flow that means that valve has developed an infection or infectious endocarditis.

If one has severe mitral valve prolapse that is not controlled with medicines.

Minimally invasive surgery may be opted for these reasons :

Changes in mitral valve may cause major heart failure symptoms, such as acute chest pain, shortness of breath, fainting spells, or eminent heart failure.

Tests show that the changes in mitral valve are beginning to harm the heart function due to damage to heart valve from infection (endocarditis).

Surgery may be deemed necessary when the valve opens or closes incompletely. A stenotic (narrow) valve does not let the blood flow easily into the heart causing blood to "back up" and pressure to build up in the lungs. This makes it tough for the heart to increase the amount of blood that it pumps with exercise, and may produce symptoms as shortness of breath - especially activity induced. If the leaflets do not meet correctly for any reason (and many things may cause this), blood may leak backward into the lungs each time the heart pumps blood. Since some amount of blood leaks backwards, the heart has to pump more blood with each contraction in order to push the same amount of blood forward. This is called volume overload. The heart can compensate for this overload for many months or years, provided that the leakage is progressively slow. Eventually, the heart begins to fail in its primary activity and patients show symptoms of shortness of breath or fatigue (tiredness).

Causes of the mitral valve problems :

Mitral valve problems are rarely caused by a birth defect known as a congenital condition. More often, simple "wear and tear" may cause part of the valve mechanism to crash and is called "degenerative disease". This may correspond to advancing age, although many young people will have this condition as well. Rheumatic fever damages the mitral valve causing stenosis or regurgitation. Occasionally the mitral valve is damaged by infection or bacterial endocarditis. Coronary artery disease can also cause the mitral valve to leak.

Treatment for the mitral valve problems :

For both stenosis and regurgitation, valve repair surgery is typically preferred to Valve Replacement Surgery. If repair surgery is not a good option, replacement surgery may be recommended.

An artificial mitral valve may or may not work as well as a normal mitral valve, So your doctor will likely recommend valve replacement only if it is deemed necessary. It might be necessary if the valve has deteriorated to the point that repair is not an option or if the anatomy of the valve has been changed by one or more repair procedures and can no longer be repaired.

The doctor will also consider age and overall health condition when you are deciding whether to opt for surgery or not. In most cases, however, the valve is too damaged to permit repair and the valve must be replaced with a prosthetic (artificial) valve.

Types of valves available for the treatment :

In general there are two types of artificial valves available – mechanical valves made from metal and pyrolytic carbon.

Biological valves made from animal tissues. Each has its own advantages and risks with respect to durability (how long they will last) and risk of blood clots forming on the valve. The choice of which type to use should be made by doctors taking the following into consideration :

Age and other medical conditions, preferences with regard to medications and the risk of reoperation and present lifestyle.

Mechanical valves :

Excellent mechanical prostheses flood the markets. All perform equally well. The principle advantage of mechanical valves is their excellent durability. The valves available today simply do not wear out. The main disadvantage is that blood has a tendency to clot on all mechanical valves in certain circumstances. If this happens the valve will not function normally. Therefore, patients with the same valves must take anticoagulants for life which is manageable.

Biological valves :

There are variety biological alternatives for mitral valve replacement. Most are made from cow or pig tissues. Their key advantage is that they have a reduced risk of blood clots forming on the valve itself causing valve dysfunction or stroke. The key disadvantage of biological or tissue valves is that they have more limited durability as compared to mechanical valves. They will wear out given enough time. The rate at which they wear out, however, depends on the patient's age. Biological valves are usually preferred for ages over and above 65 years.

Risks of the surgery :

The exact risks of mitral valve surgery vary depending on the person's specific condition and general health prior to surgery. Young, healthy people have lower risk of problems while the elderly with other health problems have higher risk involved. Your cardiologist and cardiothoracic surgeon can best determine individual risk of surgery. It will depend on factors such age, general health condition, specific medical conditions, and your heart function.

How to perform Mitral Valve Replacement Surgery ?

Mitral Valve Replacement Surgery may be needed for mitral valve regurgitation or mitral valve stenosis. Valve replacement is done as an Open-Heart Surgery.

Before valve replacement surgery the doctor will decide the type of valve is right to be replaced based on prognosis of the patient.

During surgery, general anaesthesia is administered. The surgeon makes a big incision in your chest. Placement of the patient on a heart-lung machine during the surgery is a essential. Blood is circulated outside of the body and oxygen is pumped to it using a heart-lung (cardiopulmonary bypass) machine. To protect the heart muscle from damage in event of the surgery, the heart may be cooled to slow or stop the heartbeat. The damaged mitral valve is pulled out and replaced with an artificial heart valve.

Before the Procedure

  • Pregnancy test is a must.
  • Medication is a must
  • Additional blood might be required
  • Smoking must be stopped.

After the Procedure :

  • Minimum stay in the hospital is for 3 to 5 days only. A day after surgery would have to be spent in the intensive care unit.
  • Two to three tubes will be in the chest to drain fluid from around the heart. They are usually removed 1 - 3 days after surgery.
  • Our abled nursing staff will help you start activity slowly. We begin a program to make the heart and body stronger.
  • A pacemaker may be placed in the heart if the heart rate shows any signs of fluctuations.

Recovery :

Recovery from the heart valve surgery usually involves a few days in an intensive care unit (ICU) of a hospital. Our experts at KIMS will ensure a step by step procedure to build your general health increase your endurance and strength. Follow up visits and constant monitoring will ensure you recover as fast as possible.

Life after surgery :

Life eventually returns to normalcy if the procedures laid down by the doctors are adhered to. Proper diet and exercise regimen must be followed.

  • Complications such as shortness of breath, difficulty in breathing will be reduced gradually three to four weeks of the surgery.
  • The surgical `wounds will begin healing with the antibiotics and pain killers being put to use.
  • Normal activities can be resumed within four to six weeks after the surgery
  • Anti-coagulants may have to be administered for life.

How Well It Works and quality of life :

After the mal-functioning mitral valve is replaced, the artificial valve works more like a normal valve and allows blood to flow normally through the heart. The recovery of the patient corresponds to his life style changes such as not smoking, avoiding alcohol, good diet habits and exercises.



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