Mitral Valve Repair Surgery

Diagnosis: The following diagnostic tests are performed before a mitral valve repair surgery:

1. Physical examination: The patient’s symptoms and medical history are noted by the surgeon. A stethoscope is used to hear the heartbeat of the patient. A heart murmur may indicate the blood leaking back into the left atrium, whereas a clicking sound may indicate a mitral valve prolapse.
2. Echocardiogram: This test is performed to obtain clear images of the heart. 
3. Transesophageal echocardiogram: A flexible device with a small device, known as a transducer, is attached to the throat and passed down the esophagus (food pipe) to obtain clear images of the heart and its valves.
4. Chest x-ray: The heart, lungs, and blood vessels in the chest region can be checked using a chest x-ray.
5. Electrocardiogram (ECG): The electrical activity of the heart can be measured using this test.
6. Coronary angiogram: The blood vessels of the heart can be checked with the help of x-rays in this test. 
7. Stress test: Various parameters of the patient are checked while performing certain physical exercises in this test.

Procedure:
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:

1.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.

2. 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.

3. 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. 

4. 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:
 1. 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.

2. 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.

3. 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).

4. 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.

5. 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.

A mitral valve repair surgery may have the following complications:

• Infection
• Bleeding 
• Formation of blood clots
• Allergic reactions to the anesthesia used
• Arrhythmias (irregular heart rhythms)
• Heart block (partial or complete blockage of the electrical signals that control the heartbeat)
• Heart failure (failure of the heart to pump sufficient blood to the remaining body)
• Stroke (when the blood flow to the brain is interrupted)

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 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.
The patient should have follow-up appointments with the doctor, as recommended.
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 contact the doctor if he/she notices any signs of infection after surgery.