Mitral Valve Surgery

Purpose: A mitral valve replacement surgery is required in the following cases:
1. Mitral valve stenosis:
A condition that occurs when the mitral valve is not able to open completely. Therefore, less blood can flow from the left atrium into the left ventricle.

2. Mitral valve regurgitation:
This condition occurs due to a leaky mitral valve. Some blood tends to leak back into the left atrium, instead of going ahead into the left ventricle.

3. Coronary artery disease or ischemic heart disease:
This condition occurs due to the accumulation of plaque in the blood vessels that supply blood to the heart. This decreases the blood flow to the heart.

4. Infectious endocarditis:
This condition is seen due to an infection of the heart valves. It is commonly seen in people with damaged or artificial heart valves.

5. Heart failure:
When the heart cannot pump sufficient blood to the body, it leads to a condition known as heart failure. It causes an insufficient supply of blood and oxygen to the body.

6. Rheumatic fever:
A streptococcal bacterial infection that leads to the infection and inflammation of the valves of the heart, blood vessels, and joints is called rheumatic fever. This leads to mitral valve scarring and stenosis.

7. Mitral Valve prolapse that cannot be treated using medicines:
Mitral valve prolapse is a condition that occurs when the mitral valve bulges back into the upper left chamber of the heart while the heart muscles are contracting to supply blood. This can be heard as a heart murmur in the stethoscope by a doctor. In certain cases, this condition can not be treated with medications, and mitral valve surgery will be required to correct the damaged mitral valve.

Symptoms of Mitral Valve Diseases:The various symptoms associated with mitral valve disorders, which may indicate the need for a mitral valve replacement surgery:

• Breathlessness or difficulties in breathing

• Dizziness

• Fatigue

• Arrhythmia (irregular heartbeat)

• Palpitations (noticeable heartbeats)

• Chest pain

• Swelling or edema of the ankles, feet, or abdomen (stomach)

• Fluid retention causing quick weight gain

1. Physical examination: The doctor will listen to your heart using a stethoscope. A clicking sound may indicate a mitral valve prolapse, while a heart murmur can indicate leaking of blood back into the left atrium.

2. Echocardiogram: This is a non-invasive ultrasound test for the heart. High-frequency sound waves are used to create clear images of the heart. It can help the doctor to view the blood flow through the mitral valve and measure the amount of regurgitation or leakage of blood.

3. Transesophageal echocardiogram: A flexible device with a small device, known as a transducer, is attached to the throat and down the esophagus (food pipe) to obtain clear images of the mitral valve and the heart.

4. Chest x-ray: This x-ray helps in obtaining a picture of the lungs, heart, and blood vessels.

5. Electrocardiogram (ECG): This is a non-invasive test done to record the electrical activity of the heart. It helps in detecting the irregularities in your heart.

6. Stress test: A mitral valve regurgitation limits the ability to exercise. The doctor may recommend certain exercises or medications to increase the heart rate and make the heart work harder during the test.

7. Coronary angiogram: This test uses an x-ray to see the blood vessels of the heart. It helps the doctor in determining the severity of the condition.

The mitral valve replacement surgery is generally done under general anesthesia (the patient is put to sleep during the procedure), and can be performed in the following ways:

1. Open mitral valve replacement surgery:

• The doctor will make an incision down the middle of the chest.
• The surgeon will separate the breastbone to access the heart.
• The doctor will attach you to a heart-lung or bypass machine. This machine performs the function of the heart and lungs during the procedure.
• The surgeon will remove the damaged mitral heart valve and then replace it with a new valve.
• The heart-lung machine is then removed.
• The surgeon will wire the breastbone back together.
• The surgeon will then staple or stitch (suture) the incision in the skin back together.

2. Minimally invasive mitral valve surgery:

• The surgeon will give a 2 to 3-inch incision along the chest near the breastbone. 
• The muscles in this area are then separated to reach the heart.
• A small incision or cut is then made on the left side of the heart for replacing the mitral valve.

3. Endoscopic surgery:

• The surgeon makes one to four small holes in the chest region.
• The surgeon then performs mitral valve surgery by using the camera on the endoscope and special surgical tools that can be inserted through these holes.

4. Robotically-assisted mitral valve surgery:

• This kind of surgery is performed by making 2 to 4 tiny cuts in the chest region. These incisions are approximately 1.5 to 2 centimeters in size.
• A special computer is used by the surgeon to control the arms of the robot during the surgery.
• The surgeon can view the complete 3D view of the mitral valve and heart on a computer monitor in the operating room.

5. Transcatheter procedure:

• This procedure involves the insertion of a catheter in a vein.
• This catheter is guided to the heart and may be used for delivering tools for the replacement of the valve.

The risks associated with mitral valve replacement surgery include:

• Bleeding

• Infection

• Blood clot formation

• Irregular heart rhythms

• Allergic reactions to anesthesia

• Continuation of the leakage of the valve

• Damage to the organs nearby

• Dysfunction of the replacement valve

• Loss of memory

• Problems in concentrating

• Stroke (blood flow to the brain stops)

• Death

• You will be spending a day or two in the intensive care unit (ICU) following the surgery.

• You will then be moved to a regular hospital room from the ICU. 

• You will stay in the hospital for 3 to 5 days after the procedure.

• It is normal to feel tired and sore for a few weeks after the surgery. The symptoms usually improve after 4 to 6 weeks.

• Two or three tubes are placed in the chest to drain out the fluid from the heart. These tubes are removed one to three days after the surgery.

• Stitches or sutures are removed by the surgeon 7 to 10 days after the procedure.

• A temporary or permanent pacemaker may be placed by the surgeon in the patient’s heart after the surgery if the heart rate falls down too much after the surgery.

• Proper hygiene should be maintained after going home to prevent infection.

• The medications prescribed by the doctor should be taken regularly.

• Strenuous physical activity should be avoided after the surgery.

• Resume your daily activities only after the doctor permits you for the same.

• Contact your doctor if you have a fever or notice a drastic change in weight after the procedure.

• Regular follow-up appointments with your doctor are recommended after the surgery.