by Ricker Polsdorfer, MD
En Espaol (Spanish Version) When the mitral valve in the heart is incompetent or tight, it may need to be replaced.
The mitral valve controls blood flow through the left side of the heart.
Fully-functioning, competent heart valves permit free, one-way flow of blood. Diseased valves either leak, causing back flow, or narrow, causing restricted flow. In either case, the condition can be life threatening. Sometimes the valve can be repaired. At other times it must be replaced surgically. Rheumatic fever , infections, and congenital defects are the most common diseases of the mitral valve.
The demands of open heart surgery are severe. The better your general health, the less likely you will experience a complication. Diabetes , heart disease, blood clotting disorders, and cancer are some of the risk factors that must be evaluated before you undergo this procedure.
Only half to three-quarters of all mitral valves can be repaired. You will be thoroughly evaluated. Your doctor will evaluate both your general health and the condition of your heart and circulation. Expect several heart tests including an electrocardiogram (EKG) and an echocardiogram (using ultrasound). You will most likely be in the hospital for several days before the surgery.
Also, in the days leading up to your procedure: Do not to eat or drink anything starting the night before your procedure.Tell your doctor about any medications, herbs, or supplements that you are taking. Anesthesia You will have a general anesthetic . Description of the ProcedureThe standard open procedure requires an incision be made the length of your breast bone. The breast bone will be split lengthwise to expose your heart. You will be put on a heart-lung machine so that your heart can stop during the procedure.Your heart will be opened, and a substitute valve will be sewn into place. This valve may be mechanical (metal and plastic), such as a St. Jude valve, or made of tissue. Tissue valves most commonly come from a pig (porcine valve) or a cow (bovine valve), but they may also be supplied by a human donor or even manufactured from your own tissues. Mitral Valve Replacement 2008 Nucleus Medical Art, Inc. Newer techniques, including robot-assisted procedures , are being developed that require smaller incisions. After ProcedureYou will remain in the hospital for several days so doctors can observe any complications, stabilize your heart function, and instruct you in homecare and activities.
How Long Will It Take?The surgery takes approximately 2 to 5 hours. Will It Hurt?Your chest and back will be sore following the surgery. Possible Complications Every complication possible from major surgery can follow open heart surgery. Bleeding, infection, and drug reactions are the most common. Strokes and heart attacks also occur rarely. Average Hospital StayYou will probably spend 1 to 3 days in the intensive care unit (ICU) and a week in a regular hospital room. Postoperative CareIf you have a mechanical valve, you will need to take blood thinners for an extended period of time to prevent blood clots. You may also need to take antibiotics during dental and certain other procedures to prevent infection. You will be prescribed a carefully graded return to your usual activities over 4 to 12 weeks and probably participate in a cardiac rehabilitation program.Mechanical valves last a lifetime. Tissue valves last 7 to 14 years and then must be replaced. OutcomeIf your valve is repaired and you have no complications, you will likely do well and be able to return to normal activities. Call Your Doctor If Any of the Following Occurs Excessive nausea, diarrhea , constipation , or stomach pain VomitingFeverWorsening ankle swellingWeight gain over two pounds in two daysDizzy or lightheaded when standingConfusionTingling in hands and feetExtremely slow or fast pulseIrregular heartbeatSkin rashUnusual bruising or bleedingTrouble breathingChest painCoughing up bloodBloody or tarry bowel movementSevere headacheDrainage from the incision(s)Burning urine RESOURCES:
American Heart Associationhttp://www.americanheart.org The Society of Thoracic Surgeonshttp://www.sts.org Texas Heart Institutehttp://www.texasheartinstitute.org University of Maryland Heart Centerhttp://www.umm.edu CANADIAN RESOURCES: Mount Sinai Hospital, Canadahttp://www.mtsinai.on.ca University of Ottawa Heart Institutehttp://www.ottawaheart.ca/ References: The Cardiothoracic Surgery Network website. Available at: http://www.ctsnet.org/sections/clinicalresources/adultcardiac/riley.html . Accessed August 31, 2005. Mitral valve disease. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/diseasemanagement/cardiology/mitralvalve/mitralvalve.htm . Accessed 8/31/05. Accessed August 31, 2005. Mitral valve regurgitation. Mayo Clinic website. Available at: http://www.mayoclinic.com/ . Accessed August 31, 2005. Society of Thoracic Surgeons website. Available at: http://www.sts.org/doc/4107 . Accessed August 31, 2005. Last reviewed November 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
