Mitral valve replacement is a cardiac surgical procedure performed to replace a mitral valve not functioning properly. Mitral valve is located between left heart chambers i.e left atrium and left ventricle. The valve replacement is an open-heart surgery, in few cases a minimally invasive surgery or a catheter procedure may be possible.
Indications for Mitral Valve Replacement
- Mitral Valve Stenosis- When a mitral valve does not open fully and restricts blood flow, may be due to an infection (infectious endocarditis).
- Mitral Valve Regurgitation - When a mitral valve does not close properly and allows blood to leak back into the left atria.
- severe mitral valve prolapse
Signs and Symptoms
May be asymptomatic for many years. Signs and symptoms of mitral valve disease may include:
- Heart murmur on auscultation
- Easy fatigue
- Swelling in ankles and feet
- Irregular heartbeat
Tests and Diagnosis
- Physical Examination- on auscultation physician will hear a heart murmur.
- Echocardiography- An echocardiogram helps your doctor understand the mitral valve and how well it's working.
- Transesophageal Echocardiogram
- Electrocardiogram (ECG). An ECG can detect enlarged chambers of heart, heart disease and abnormal heart rhythms.
- Chest X-ray
- Cardiac MRI
- Stress Tests
- Standard blood tests are performed to check fitness for surgery.
- Patient counselled about the procedure and after care.
- Procedure performed under general anaesthesia.
- IV line inserted, breathing tube is inserted.
- Incision made in middle of chest, surgeon separates sternum to expose pericardium, then opens pericardium to expose heart.
- Connects heart to heart lung machine, tubes are used to reroute the blood into machine which takes over the function of heart and lung during the operation.
- Heart is temporarily stopped and blood removed, valve is still and allows surgeon to see it.
- Surgeon makes incision around edge of damaged valve and replaces it.
- After valve replacement, patient usually need to stay in hospital for about a week.
- You will be kept in intensive care unit (ICU) for initial days.
- The activity of your heart, lungs and bodily functions will be closely monitored, ventilator will be placed until you are able to breathe.
- Draining tube – small tubes from your chest to drain away any build-up of blood or fluid.
- Pacing wires – if necessary, these will be inserted near the chest drains to control your heart rate.
- Adviced to follow a cardiac rehabilitation programme.
- Avoid strenuous exercise, sudden strains and heavy lifting for three months.
- You will be able to perform usual activities after 4 to 6 weeks.
- Report to the physician if any warning signs of infection.
- Consult your doctor regularly to check for efficiency of heart valve.
- If you have a mechanical heart valve, necessary to take anticoagulant medicine to help prevent clots.
Minimally Invasive Mitral Valve Surgery
In endoscopic surgery, your surgeon makes 1 to 4 small holes in your chest. Surgery is done through the cuts using a camera and special surgical tools.
Robotically-Assisted Valve Surgery
The surgeon makes 2 to 4 tiny cuts in your chest, the surgeon uses a special computer to control robotic arms during the surgery.
Complications of Valve Surgery
- Excessive bleeding
- Risk of infections
- Blood clotting
- Infection around the artificial valve
- Irregular heartbeat or arrythmia
- Failure of the new valve
- Pulmonary oedema, pulmonary thromboembolism
- Renal failure
Factors Affecting Cost Of Mitral Valve Replacement
- The cost to the patient depends on a variety of factors like
- The hospital, the patient chooses
- Type of Room
- Fee for the team of doctors and OT charges
- cost of medications
- Standard test and diagnostic
- cost of the valve
- Cost of the follow –up care required after the procedure