What is the Mitral Valve Repair Surgery
July 18, 2022 Heart Diseases 445 ViewsWhat is the meaning of Mitral Valve Repair Surgery?
A surgical procedure performed to repair a diseased mitral valve is known as mitral valve repair surgery. The mitral valve is one of the four valves present in the heart. The mitral valve is situated between the left atrium and the left ventricle (upper and lower left chambers) of the heart and helps blood flow through the heart and out into the body. Mitral valve repair surgery is recommended over mitral valve replacement surgery, especially in cases of valve leaks. However, in certain cases, mitral valve replacement may be the only or best option available.
In this article, we will be discussing in detail about mitral valve repair surgery-
- What is the purpose of Mitral Valve Repair Surgery?
- What are the symptoms that indicate the need for a Mitral Valve Repair Surgery?
- What is the diagnostic procedure before a Mitral Valve Repair Surgery?
- How to prepare for Mitral Valve Repair Surgery?
- What is the procedure for Mitral Valve Repair Surgery?
- How to care after Mitral Valve Repair Surgery?
- What are the risks of Mitral Valve Repair Surgery?
- What is the cost of Mitral Valve Repair Surgery in India?
What is the purpose of Mitral Valve Repair Surgery?
A mitral valve repair surgery is performed in the following cases:
Mitral valve regurgitation:
- Commonly known as a leaky mitral valve, the flaps of the mitral valve do not close properly.
- This leads to some blood leaking back into the left atrium instead of moving forward into the left ventricle.
Mitral valve stenosis:
- The narrowing of the mitral valve opening can result in stenosis.
- This leads to less blood flowing from the left atrium into the left ventricle.
Mitral valve prolapse:
- This condition occurs when the mitral valve flaps are too stretchy or floppy.
Endocarditis:
- A condition in which there is an infection in the heart valve is known as endocarditis.
- After the removal of all the infected tissue from the valve, if there is any healthy tissue remaining, the surgeon will reconstruct the valve.
Mitral calcification:
- If there are many calcium deposits on the valve leaflets (flaps) or annulus (the base of the valve that supports the leaflets).
What are the symptoms that indicate the need for a Mitral Valve Repair Surgery?
The different symptoms associated with mitral valve disorders, which could indicate the need for a mitral valve repair surgery are:
- Breathlessness
- Shortness of breath
- Difficulty in breathing
- Fatigue
- Dizziness ( Know more about- What is Dizziness ? )
- Irregular heartbeat (arrhythmia)
- Heart murmur (swishing sound by the doctor through a stethoscope due to abnormal blood flow over the heart valves)
- Swelling of the ankles and feet
What is the diagnostic procedure before a Mitral Valve Repair Surgery?
The following diagnostic tests may be performed before a mitral valve repair surgery:
- Physical examination: The patient’s symptoms and medical history are noted. The doctor uses a stethoscope to hear the heartbeat. A heart murmur could indicate the blood leaking back into the left atrium, while a clicking sound could indicate a mitral valve prolapse.
- Echocardiogram: High-frequency sound waves are used to create clear images of the heart. ( Know more about- What is Echocardiography? )
- Transesophageal echocardiogram: This procedure involves attaching a flexible device with a small device, known as a transducer, to the throat and passing it down the esophagus (food pipe) to obtain clear images of the mitral valve and heart.
- Chest x-ray: The condition of the heart, lungs, and blood vessels in the chest area can be checked using a chest x-ray.
- Electrocardiogram (ECG): The electrical activity of the heart is measured in this test.
- Stress test: This test involves the evaluation of the patient while performing certain physical exercises.
- Coronary angiogram: An x-ray is used in this test to view the heart’s blood vessels.
How to prepare for Mitral Valve Repair Surgery?
The following preparation may be done before a mitral valve repair surgery:
- Inform the doctor if the patient has any underlying medical conditions.
- Inform the doctor if the patient is taking any herbs, supplements, or medications.
- If the patient has any known allergies to anesthetic agents, latex, iodine, or tape, inform the doctor about the same.
- The patient has to quit smoking at least two weeks prior to the surgery.
- The patient cannot eat or drink anything after midnight, the day before the surgery.
- The doctor recommends stopping blood-thinning medications like aspirin and warfarin a few days before the procedure.
- Any medications that need to be taken on the day of the surgery can be taken with small sips of water.
- The patient is given an antimicrobial soap that needs to be used the night before the surgery.
What is the procedure for Mitral Valve Repair Surgery?
The mitral valve repair surgery is usually done under general anesthesia (the patient is put to sleep before the procedure).
Mitral valve surgery may be done in the following different ways:
- Annuloplasty:
- This procedure involves the placement of a partial or complete ring around the rim of the mitral valve, known as the annulus.
- This ring may be rigid or flexible.
- This tightens or reinforces the reshaping of the mitral valve so that it can function properly.
Quadrangular or triangular resection:
- This technique is usually used for posterior leaflet prolapse (the mitral valve is made up of two flaps, namely the anterior and posterior leaflets)
- The procedure involves the removal of the damaged part of the leaflet and then sewing the remaining edges together.
- The surgeon normally makes a small, triangular cut for removing the damaged part.
- If a larger part of the leaflet is diseased, the surgeon makes a rectangular cut to remove a little bit more tissue.
Chordal repair:
- This technique is used to repair the anterior leaflet prolapse.
- This procedure involves the replacement of some of the chordae or chords (tough, fibrous strings supporting the mitral valve).
- Ruptured or extremely elongated chords are removed by the surgeon.
- New chords are then created out of tough, synthetic material and then attached.
- Alternatively, healthy chords are then taken from another area and put in place of the damaged chords.
- This procedure is known as chordal transposition or chordal transfer.
Mitral valve clip placement:
- A small metallic device known as a mitral valve clip is inserted through a catheter (thin tube) from an artery in the groin or leg region and guided to the heart.
- This clip is used to reshape the mitral valve.
- A mitral valve repair surgery can be performed using any of the following techniques:
Open mitral valve repair surgery:
- An incision or cut is made down the middle of the chest.
- The size of the incision made depends on the surgical method being used.
- The incision may go down the middle of the chest (full sternotomy), or part of the chest (partial sternotomy).
- The breastbone is then separated to access the heart.
- The heart’s function is stopped.
- The patient is attached to a heart-lung bypass machine, that performs the function of the heart and lungs during the surgery.
- The surgeon now repairs the mitral valve by putting an annuloplasty ring around the valve or by using other repair methods mentioned above.
- The heart-lung machine is then removed.
- The breastbone is wired back together.
- The incision is sutured or stapled back together. ( Know more about- What is heart bypass surgery ? )
Minimally invasive mitral valve surgery:
- This procedure is performed by making a small incision between two ribs, known as right thoracotomy.
- Mitral valve repair is carried out and the incision is closed using sutures.
Endoscopic surgery:
- The procedure is done by making one to four small keyholes in the chest area.
- Mitral valve repair surgery is now performed by using the endoscope (a tube) with a camera on one end to view the inside and other small surgical tools inserted through these holes to carry out the procedure).
Robotically-assisted mitral valve surgery:
- 2 to 4 small incisions, about 1.5 to 2 centimeters in size, are made in the chest region.
- The surgery is performed in a manner similar to endoscopic surgery, but by using robotic arms.
- The surgeon controls the robotic arms during the surgery by viewing the monitor.
Transcatheter procedure:
- This procedure involves the insertion of a catheter in a vein in the leg or groin region.
- This catheter is then guided to the heart and can be used to place the mitral valve clip and reshape the mitral valve.( Know more about– What is TAVI? )
How to care after Mitral Valve Repair Surgery?
The following are the post-procedure steps after a mitral valve repair surgery:
- The patient spends one or two days in the intensive care unit (ICU) after the surgery.
- The patient is later moved to a regular hospital room from the ICU.
- The patient is normally discharged after a 3 to 5 days stay in the hospital.
- It is normal to feel some soreness and fatigue for some weeks after the surgery. These symptoms usually subside on their own within 4 to 6 weeks.
- Two or three drainage tubes are placed in the chest area to drain out the fluid accumulated in the heart region. These drainage tubes are usually removed one to three days after the surgery.
- Stitches are usually removed after 7 to 10 days of the procedure.
- The patient should follow all the instructions and maintain proper hygiene after going home to prevent any infection.
- The medicines recommended by the doctor should be taken properly.
- Heavy lifting and strenuous activities should be avoided for a few weeks after the surgery.
- The patient can resume his/her daily activities only after the doctor permits the same.
- The patient should immediately contact the doctor if he/she notices a fever or a drastic weight change after the surgery.
- Regular follow-up appointments with the doctor are a must after the surgery.
What are the risks of Mitral Valve Repair Surgery?
The various complications associated with a mitral valve repair surgery are:
- Bleeding
- Infection
- Blood clot formation
- Allergic reactions to the anesthetic agent used
- Arrhythmias (irregular heart rhythms) ( Know more about- What are Arrhythmias of Heart ? )
- Heart failure (failure of the heart to pump enough blood to the rest of the body)
- Heart block (when the electrical signals controlling the heartbeat are partially or completely blocked)
- Stroke (a condition in which the blood flow to the brain is interrupted)
What is the cost of Mitral Valve Repair Surgery in India?
The total cost of mitral valve repair surgery in India can range from around INR 3,25,000 to INR 5,25,000. However, there are many large hospitals and experienced doctors in India who perform mitral valve repair surgery. But the cost of mitral valve repair surgery may vary across different hospitals.
If you are coming from abroad, apart from the cost of mitral valve repair surgery, there will be a cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the procedure, the patient stays in the hospital for 5 days and in the hotel for 10 days for recovery. So, the total cost of mitral valve repair surgery will be around INR 4,90,000 to INR 6,00,000.
We hope that we could answer your questions regarding mitral valve repair surgery through this article.
If you need more information about mitral valve repair surgery, you can contact a Cardiovascular and Thoracic Surgeon.
We only aim to give you information through this article and do not recommend medication or treatment in any way. Only a qualified doctor can give you good advice and a treatment plan.