Cancer

Mitral Valve Repair

Description

Mitral valve refers as one of the two major valves on the left side of the heart containing two flaps known as cusps that allows blood flow from the left atrium to the left ventricle. It prevents the blood from flowing backward into the heart. Mitral valve disease occurs when the mitral valve does not perform with full efficiency.

Mitral valve repair is a kind of open cardiac surgery to treat the narrowing and leakage of the mitral valve. The procedure includes implanting a ring covered in cloth around the valve to make every flaps in contact, remove loose segments of cusps and re-suspension of flaps with Goretex cords.

Surgical  procedure

Cardiopulmonary Bypass

Standard Bypass requires perfect positioning of patient. Exposure, Arterial inflow and venous drainage through multiple specialized procedures like caval snares are used in inflow occlusion. Proper care is done while placing left ventricular vent, delivering cardioplegia and inserting LV vent. Post repair, the vent passes through the mitral valve and later the vent is eliminated.

Valve Exposure

Reliable exposure is necessary to achieve unfailing  mitral valve exploration and repair surgeries with a superior-septal incision. Valve exposure surgeries require two surgeons on the same side of the table.   Exposure is achieved during cardioplegia. After the whole process aorta 4-0 Prolene traction sutures are positioned to help exposure.

Other procedures used by surgeons to repair the valve are:

  • Commissurotomy: A surgeon in this procedure cuts the points where leaflets meet to narrow the valves that are stuck together.
  • Valvuloplasty: This toughens the leaflets and offer more support to valves through a ring like device attached outside the valve.
  • Reshaping: It is used to part the leaflets and sewn back again so the valve can be closed properly.
  • Decalcification: This allows the leaflets to eliminate calcium build up so that they can close appropriately.
  • Repair: It refers to repairing the cord’s length.
  • Patching: It used to fill the tears and holes in the leaflets.

Valve replacement is also done to cure the severe valve damage that includes aortic and mitral valve. The replacement consists of two types, which are – Mechanical valves and Biological valves

 

 

Complications

Similar to any other cardiac surgery, mitral valve repair also contains some complications that include infection, bleeding or reaction to anesthesia. These complications vary according to the patient’s age, health condition and heart’s performance. Psychopathologic and neuropsychological alteration has also been witnessed after mitral valve replacement surgery. It is difficult to determine the aftereffects as the duration of symptoms, phenomenology and incidence diverge in every case. Other complications after the surgery includes:

  • Atrial fibrillation that occurs in 32% of the patients
  • Congestion
  • Prolonged ventilation for over a day in conditions such as ARDS, pulmonary edema and thrombiemboli
  • Renal failure
  • Permanent strokes

Post operative care

There are certain measures to take after the mitral valve repair from the very first day and will continue until the following weeks as you will feel incredibly tired and sleepy. This includes breathing exercises in every 2 hours, which is followed by drinking fluids and having soft food. All your monitoring equipments will be removed after a day along and you will be able to walk out of your bed. During this time, your metabolic and nutritional features will be thoroughly managed where insulin will be used to keep your blood sugar level intact, and liquid and food intake will keep on increasing as your condition improves. Your blood test and chest x-ray will be reviewed to confirm your overall health and you will be prepared for discharge.

After you are discharged from the hospital, you will be required to visit your cardiologist in a week, followed by a 4-week appointment with your surgeon. You can take a shower with dry towel. Heavy lifting is strictly prohibited for a few weeks to come and you will be restrained from driving as well.