iPedia Free Information Center

Information about Mitral Valve Replacement

Mitral valve replacement is a cardiac surgery procedure in which a patient’s mitral valve is replaced by a different valve. Mitral valve replacement is typically performed robotically or manually, when the valve becomes too tight (mitral valve stenosis) for blood to flow into the left ventricle, or too loose (mitral valve regurgitation) in which case blood can leak into the left atrium and back up into the lung (The Society 1). Some individuals have a combination of mitral valve stenosis and mitral valve regurgitation or simply one or the other.

A mitral valve replacement/repair is performed to treat severe cases of mitral valve prolapse, heart valve stenosis, or other valvular diseases (BCM Para 1). Since a mitral valve replacement is an open heart surgical procedure, it requires placing the patient on cardiopulmonary bypass to stop blood flow through the heart when it is opened up (The Society 1).

A mitral valve replacement is necessary when the valve doesn’t open or close completely. When the valve narrows or is stenotic the valve doesn’t let blood flow easily into the heart causing the blood to "back up" and pressure to build up in the lungs (The Society 2). This is dangerous because when the leaflets in the valve don’t meet correctly, blood may leak backwards into the lungs each time the heart pumps. If blood leaks backwards, the heart has to pump harder in order to push the same amount of blood forward. This is known as volume overload. The heart may compensate for this overload for many months or even years but eventually the heart begins to fail and patients show symptoms of shortness of breath or fatigue (The Society 2).

Causes

Mitral valve problems are mainly cause from simple wear and tear that causes part of the valve mechanism to fail. Rheumatic fever may also damage the mitral valve causing stenosis or regurgitation, and occasionally the mitral valve is damaged by infection or bacterial endocarditis. Coronary artery disease is also what may cause the mitral valve to leak (The Society 2).

Symptoms

Some symptoms of patients that need mitral valve repair or replacement include: sensations of feeling the heart beat, chest pain, hard to breathe especially after activity, fatigue, coughing, and shortness of breath while lying flat. These symptoms may develop slowly or the patient my not have any symptoms at all (Gandelman 1).

Options

Some surgeons will first recommend repairing the valve instead of replacement, but if the patient is not a good candidate then they must replace the valve (Maryland Para 1).

Many mitral valves can be repaired, especially if the leak is due to wear and tear. When the valve is too damaged to repair, the valve must be replaced with an artificial valve (Sundt 2). There are some advantages to repairing a mitral valve versus replacing it. Some of these advantages are; a lower mortality at the time of operation (1-2% for repair versus 6-8% for replacement), a significantly lower risk of stroke, and a lower rate of infection, improved long-term survival with mitral valve repair. Patients who receive a valve repair stay on the same survival curve as the normal population. A survival curve tends to be a graph of downward steps with the x-axis as time in months and the y-axis as percent still alive (Motulsky Ch 6). After mitral valve repair, blood thinners are not required, in contrast to the life-long requirement for blood thinners after mechanical mitral valve replacement (University 1).

Non-Surgical Options

Most patients can endure surgery without complications; however there are some whose heart functions is too weak to withstand surgery. Some non surgical approaches to treat heart valve disease without surgery are divided into three categories: Clinical Practice treatment (this is used in every day clinical practice), Investigational treatment (current clinical studies that are underway), Early Development treatment (early stages of investigation) (Heart Para 3).

Types of Valves

There are two primary types of artificial mitral valves -- a metal or mechanical valve and a tissue valve or biological valve (Maryland Para 2). The mechanical valves are made entirely from metal and pyrolytic carbon and last a lifetime (Sundt 2). With this valve, patients are required to take blood-thinning medications to prevent clotting. The tissue valve is made from animal tissues (Sundt 2). The tissue valve doesn’t require a patient to take blood thinners, but it only last 10 to 15 years (Maryland Para 2). The choice of which type to use should be made by you and your doctors taking the following into consideration: your age, medical condition, preferences with medication, lifestyle (Sundt 3).

Details of the procedure

A mitral valve replacement procedure is performed under general anesthesia, which will keep you asleep during the whole surgery (BCM Para 1). The preferred method is to first make an incision under the left breast rather than through the breastbone in the front of the chest, to get to the heart. After the heart is exposed, blood must be rerouted to a heart-lung machine (cardiopulmonary bypass) (BCM 1). An incision is made in the left atrium to expose the mitral valve. The valve is then replaced with either a biological valve or mechanical valve. The heart is then closed with sutures (BCM 1). The patient is then taken off the cardiopulmonary bypass and blood is allowed to flow into the coronary arteries. If the heart does not beat on its own, an electric shock is used to start it. Then the chest is closed up (BCM 1).

Risks

With mitral valve replacement surgery, there are risks such as bleeding, infection, or a complicated reaction to anesthesia (BCM 2). Each risk is determined best with each patients own cardiologist and cardiothoracic surgeon. They will better know each individuals medical history and conditions. Risks depend on a patient’s age, general condition, specific medical conditions, and heart function (Sundt 3).

Postoperative Complications/ Risks

A common postoperative complication with mitral valve surgery in a study involving 99 patients who had surgery for mitral regurgitation from January 1990 to June 1996 is atrial fibrillation. This occurred in 32% of patients. A common pulmonary complication is congestion necessitating prolonged use of oxygen. Other patients required prolonged ventilation of longer than 24 hours for conditions like pulmonary edema, ARDS, and pulmonary thromboemboli (Hurley 1). Nine patients had renal failure with six of them dying within 30 days after their operation. Five patients had permanent strokes, and nine patients were readmitted to the hospital within 30 days of their discharge (Hurley 1).

Effectiveness

In a clinical study done of 99 patients who had mitral valve surgery for regurgitation from January 1990 to June 1996, long-term and short-term outcomes were evaluated. These evaluations included; mortality rate, clinical complications, readmissions, valve deterioration, reoperation, and health perception. Overall mortality was 18%, which included 11 operative deaths and 7 late deaths. Overall 5-year survival rate was 79% (Hurley 1).

Condition after mitral valve replacement

After the surgery the patient is taken to a post-operative intensive care unit for monitoring. A respirator may be required for the first few hours or days after surgery. After a day, the patient should be able to sit up in bed. After two days, the patient may be taken out of the intensive care unit. Patients are usually discharged after about seven to ten days (BCM 1). If the mitral valve replacement is successful, patients can expect to return to their regular condition or even better. Patients who have biological valve are prescribed blood thinners (Anticoagulation) with Coumadin for 6 weeks to 3 months postoperative, while patients with mechanical valves are prescribed blood thinners for the rest of their lives. These blood thinners are taken to prevent blood clots that can move to other parts of your body and cause serious medical problems, such as a heart attack. Blood thinners will not dissolve a blood clot but they prevent other clots from forming or prevent clots from becoming larger. Blood thinners will not dissolve (Heart Disease 1). Once the patient’s wounds are healed they should have few, if any restrictions from daily activities (Sundt 1). Patients are advised to walk or to do other physical activities gradually to regain strength. Patients who have physically demanding jobs will have to wait a little longer than those who don’t. Patients are also restricted from driving a car for six weeks after the surgery (Mitral 2). Once a person has a mitral valve procedure, they are required to have prophylactic antibiotics as a preventative measure against infection whenever they have dental work done (Sundt 4). Depending on the method of surgery, some scarring will occur. If the breastbone is divided, the patient will have a long scar along the breast bone. If the heart is accessed from under the left breast their will be a smaller scar in the spot (Mitral 2).

See also

References

External links

 •  • [ e]
Health Science – Medicine - Surgery - Cardiac surgery
Mitral regurgitation
Classification & external resources

ICD-10 I 05.1 , I 34.0 , Q 23.3
ICD-9 394.1 , 424.0 , 746.6

DiseasesDB 8275

eMedicine emerg/314   Mitral regurgitation (MR), a valvular heart disease also known as
..... Click the link for more information.
An artificial heart valve is a device which is implanted in the heart of patients who suffer from valvular diseases in their heart. When one or two of the four heart valves of the heart have a malfunction, the choice is normally to replace the natural valve by an artificial valve.
..... Click the link for more information.
MeSH D008946 Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.

Overview

In normal cardiac physiology, the mitral valve opens during left ventricular diastole, to allow blood to flow from the
..... Click the link for more information.
Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body.
..... Click the link for more information.
Health science is the applied science dealing with health, and it includes many subdisciplines. See also health science academic disciplines.

There are two approaches to health science: the study and research of the human body and health-related issues to understand
..... Click the link for more information.
Medicine is the science and "" of maintaining and/or restoring human health through the study, diagnosis, and treatment of patients. The term is derived from the Latin ars medicina meaning the art of healing.
..... Click the link for more information.
surgery (from the Greek χειρουργική meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment.
..... Click the link for more information.
Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease
..... Click the link for more information.
The aorta (generally pronounced [eɪˈɔːtə] or "ay-orta") is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation.
..... Click the link for more information.
MeSH D001014 An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location.
..... Click the link for more information.
Aortic dissection
Classification & external resources

Dissection of the aorta descendens (3), which starts from the left subclavian artery, reaching to the abdominal aorta (4). Aorta ascendens (1) and aortic arch (2) are not involved.
ICD-10 I 71.
..... Click the link for more information.
A Bentall procedure is a cardiac surgery operation involving composite graft replacement of the ascending aorta and aortic valve, with anastomosis of the coronary arteries into the graft.

History

The Bentall procedure was first described in 1968 by H. Bentall and A.
..... Click the link for more information.
Valve-sparing aortic root replacement (also known as the David procedure) is a cardiac surgery procedure involving replacement of the ascending aorta without replacement of the aortic valve. Developed by Tirone David and Christopher Feindel at the Toronto General Hospital.
..... Click the link for more information.
Marfan syndrome
Classification & external resources

ICD-10 Q 87.4
ICD-9 759.82

OMIM 154700
DiseasesDB 7845
MedlinePlus 000418
eMedicine ped/1372   orthoped/414
MeSH C17.300.
..... Click the link for more information.
Valvular heart disease is any disease process involving one or more valves of the heart. The valves in the right side of the heart are the tricuspid valve and the pulmonic valve. The valves in the left side of the heart are the mitral valve and the aortic valve.
..... Click the link for more information.
Aortic valve repair is a surgical procedure used to correct some aortic valve disorders. It is an alternative to aortic valve replacement. Aortic valve repair is performed less often and is more technically difficult than mitral valve repair.
..... Click the link for more information.
Aortic valve replacement is a cardiac surgery procedure in which a patient's aortic valve is replaced by a different valve. The aortic valve can be affected by a range of diseases; the valve can either become leaky (aortic insufficiency / regurgitation) or partially blocked (aortic
..... Click the link for more information.
The Ross procedure (or pulmonary autograft) is a cardiac surgery operation where a diseased aortic valve is replaced with the person's own pulmonary valve. A pulmonary homograft (valve taken from a cadaver) is then used to replace the patient's own pulmonary valve.
..... Click the link for more information.
Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart.
..... Click the link for more information.
Myocardium is the muscular tissue of the heart.

Relationship to other layers

The other tissues of the heart are:
  • the endocardium (inner lining, effectively a specialized endothelium)

..... Click the link for more information.
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease.
..... Click the link for more information.
ventricular septal defect in the mid-muscular part of the septum. The trace in the lower left shows the flow during one complete cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Colours are used to represent the velocity of the blood.
..... Click the link for more information.
Intervention:


ICD-10 code:
ICD-9 code: 37.33

Other codes: The maze procedure is a collection of cardiac surgery procedures intended to cure atrial fibrillation (AF), a common disturbance of heart rhythm.
..... Click the link for more information.
Septal myectomy is a cardiac surgery treatment for hypertrophic cardiomyopathy (HCM).

History

Has been successfully performed for more than 25 years.

Outcomes

Septal myectomy is associated with a low perioperative mortality and a high late survival rate.
..... Click the link for more information.
Intervention:


ICD-10 code:
ICD-9 code: 37.35

Other codes: Ventricular reduction is a type of operation in cardiac surgery to reduce enlargement of the heart from cardiomyopathy or ischemic aneurysm formation.
..... Click the link for more information.
orthotopic procedure. Notice how the back of the patient's left atrium and great vessels are left in place.]] Heart transplantation or cardiac transplantation
..... Click the link for more information.
MeSH D009202 Cardiomyopathy, which literally means "heart muscle disease", is the deterioration of the function of the myocardium (i.e., the actual heart muscle) for any reason. People with cardiomyopathy are often at risk of arrhythmia or sudden cardiac death or both.
..... Click the link for more information.
MeSH D002312

Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause.
..... Click the link for more information.
A Ventricular assist device, or VAD, is a mechanical device that is used to partially or completely replace the function of a failing heart. Some VADs are intended for short term use, typically for patients recovering from heart attacks or heart surgery, while others are
..... Click the link for more information.
Congenital heart disease (CHD) is heart disease in the newborn, and includes structural defects, congenital arrythmias, and cardiomyopathies. CHD is a defect of the heart that exists primarily at birth, and can describe a wide variety of different abnormalities affecting the heart.
..... Click the link for more information.


This article is copied from an article on Wikipedia.org - the free encyclopedia created and edited by online user community. The text was not checked or edited by anyone on our staff. Although the vast majority of the wikipedia encyclopedia articles provide accurate and timely information please do not assume the accuracy of any particular article. This article is distributed under the terms of GNU Free Documentation License.
Herod_Archelaus


page counter