Mitral valve repair surgery

A mitral valve repair surgery is performed to treat a damaged or diseased mitral valve. The mitral valve is a tissue flap located between the left atrium and ventricle. 

Human heart has four chambers for oxygenating and pumping blood to the body- two upper atriums and two lower ventricles. The blood is circulated through all the chambers. The right atrium receives unoxygenated blood from the body, which sends it to the right ventricle and then to the lungs for oxygenation.

Oxygen-rich blood from the lungs enters the left atrium, from where it travels down to the left ventricle that pumps the blood to the rest of the body. The mitral valve controls the flow of blood between the left atrium and left ventricle. Only when this valve opens properly will the blood move between the two chambers. Mitral valve also prevents the backflow of blood from the left ventricle.

(Read More - Coronary Artery Disease)

Your doctor may perform this surgery if you have the following: 

• Mitral stenosis: Mitral stenosis refers to the narrowing of the mitral valve. The symptoms of this condition may progress for 10 to 20 years after the onset of damage. Some of the symptoms of mitral stenosis include:

  • Extreme exhaustion or fatigue 
  • Shortness of breath, initially while performing activities. This may progress to shortness of breath while resting
  • Rapid, pounding heartbeats Read more: Tachycardia causes
• Mitral regurgitation: Mitral regurgitation is a condition in which the mitral valve does not close properly. The symptoms of this condition include: 
  • Fluid accumulation in the feet and legs
  • Shortness of breath during activities. Later, you may experience even during rest or minimal activities. 
  • Severe fatigue or weakness
• Mitral prolapse: Mitral prolapse is a condition in which the flaps of the mitral valve bulge into the atrium and do not close properly. The doctor may perform this surgery if you have no progress in control of mitral prolapse by medicines. Some of the symptoms of mitral prolapse are as follows:
  • Fatigue 
  • Difficulty in breathing 
  • Dizziness or lightheadedness 
  • Anxiety 
  • Chest discomfort
  • Cough
  • Rapid heartbeats 
  • Migraine

(Read More - Congenital Heart Disease)

The relative contraindications (surgery can be performed by taking proper precautions) include:

• Aortic calcification (calcium deposit on the aortic valve, which is the valve between the left ventricle and the dorsal aorta, the blood vessel that pumps blood out of the heart to the body)
• Severe mitral annular calcification (calcification in the mitral valve)
• Right or left ventricle dysfunction
• Severe emphysema
• Pulmonary hypertension (increased blood pressures in the blood vessels of lungs)
• Restrictive lung disease (a group of diseases that keep the lungs from expanding properly)

(Read More - Congestive Heart Failure)

Before the surgery, the following preparation is required:

• Your doctor will conduct a physical examination and take your medical history. You may undergo blood tests and diagnostic tests like echocardiography (this produces a moving image of the heart).
• You must abstain from eating and drinking from midnight before the surgery.
• Inform the doctor about all the medicines that you take, including non-prescription medications, supplements, or herbs.
• If you are on blood-thinning medicines like ibuprofen, aspirin, or naproxen, the doctor will ask you to stop consuming them a week or two before the surgery.
• Stop smoking a few days before the surgery.
• Inform your doctor if you are or can be pregnant.
• Tell your doctor if you have an implanted cardiac device like a pacemaker.
• You will be asked to sign a consent form before the surgery and to arrange for a friend or family member, to take you home after the surgery.

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After you arrive at the hospital, you will be asked to wear a hospital gown. The surgery will be performed in the following manner:

Pre-operative preparation:

• You will lie on a supine (on your back) position on the operation table.
• The doctor will insert an intravenous (IV) line in your hand or arm to supplement medicines and fluid.
• You will be given general anaesthesia to keep you asleep during the procedure.
• A breathing tube will be inserted inside your lungs through your mouth.
• A catheter will be placed inside your bladder to drain urine. 
• You will have a nasogastric tube (inserted in your stomach via mouth) to drain your stomach contents.
• The surgeon will attach a heart-lung bypass machine as your heart will stop during the surgery. This will ensure that your body gets oxygenated blood through the duration of the surgery.
• The surgeon will clean your chest area with an antiseptic solution before making an incision.

The surgery can be open heart or minimally invasive. For open heart surgery, the surgeon will perform these steps: 

• The surgeon will make a long cut in the middle part of your chest. 
• He/she will separate your breastbone to be able to access your heart and then cut the left side of your heart.
• Any of the below methods will be performed to repair the mitral valve:
  • Ring annuloplasty: A ring-like part of the valve is repaired by stitching another ring of metal, tissue, or cloth around the valve.
  • Valve repair: The surgeon will trim, rebuild, or shape the flaps of the valve.

The following steps are performed in minimally invasive surgery:

• The surgeon will make a small cut or one to four holes (endoscopic surgery) on the right side of your chest near to the breastbone. 
• If you have endoscopic surgery, the surgeon will use an endoscope - a special instrument with a camera - to visualise the inside of your heart. 
• The surgery will be done through a small cut on the left part of your heart.
• A ring annuloplasty or valve repair will then be performed, depending on the damage to your mitral valve. 

Once the valve is repaired, the surgeon will:

• Attach a pacemaker temporarily to adjust the pace of your heart.
• Sew your heart and remove the bypass machine. 
• Use a tube to remove the accumulated fluid around your heart. 
• Stitch the skin over your chest to close the cuts. 
• Apply a dressing.

Open heart surgery may take up to three to six hours, whereas minimally invasive will only take two to four hours to get complete.

After the surgery, you will need to stay in the hospital for up to a week. For minimally invasive surgery, your hospital stay may be less (three to five days).

You will be shifted to the intensive care unit (ICU) to recover for one or two days. Once you wake up, you can expect the following:

• A drain tube will be there that will be removed after one or three days of the surgery.
• You will be supplemented with fluids through an IV.
• You will have a breathing tube that will be removed once you are comfortable with breathing, and then the stomach tube will also be removed.

The medical team will shift you to a hospital ward once your vitals are stable. A nurse will keep on monitoring your heart and help you to move around slowly after the surgery. You may also receive painkillers to manage pain.

(Read More - Rheumatic Heart Disease)

Once you reach home, you will need the following care: 

Wound care: 

• Your wound may take about six weeks or more to heal completely. 
• You need to be careful while moving your upper body and arms for the first six weeks.
• Clean the surgical area with water and mild soap.

Bathing or shower: You can only take 10 minutes shower each time. The water should be lukewarm. Avoid soaking, swimming, or bathing in a hot tub until your wound has healed fully. 

Activity: 

• Stay active to recover fast after the surgery.  
• Try exercises like walking. This will help your lungs and heart. You should increase your pace slowly.
• Stop doing an activity if you feel chest pain, shortness of breath, or dizziness. 
• Avoid activities like lifting weights or twisting as they may cause a pulling sensation across the chest. 
• You can resume work after six to eight weeks.

Travel: Avoid travelling for at least two to four weeks after the surgery. You should seek your doctor’s permission before travelling again.

Diet: 

• You will be provided with a special diet plan after the surgery. If you are not, however, it is essential to take a balanced diet for a speedy recovery and weight control. 
• A diet low in cholesterol, fat, and high in fibre is appropriate after the surgery.
• Food high in sugar, salt, and saturated fats should also be restricted.
• Avoid processed meat.

Medications: You will be prescribed blood-thinning medications to prevent the formation of blood clots.

This surgery will improve the function of your heart and increase your chances of a better life ahead.

When to see the doctor?

Visit your doctor if you observe any of the following symptoms:

• Fever above 100.4^°F
• Bleeding gums or nosebleeds
• Difficulty in breathing 
• Dizziness
• Easy bruising 
• Increased swelling in the abdomen or legs
• Weight gain by more than 1 kilogram in a day for two days consecutively
• Irregular or rapid pulse 
• Escalating pain around the incision site 
• Redness, bleeding, drainage, or swelling on the incision site 
• Continuous nausea or vomiting 
• Weakness in limbs 
• Headache
• Coughing up blood or green/yellow mucus
• Infection

(Read More - Heart Failure treatment)

The probable risks of this surgery are as follows: 

• Damage to other organs, bones, or nerves 
• Infection to the lungs, kidneys, chest, heart valve, or bladder 
• Blood loss
• Heart attack or stroke 
• Kidney failure
• Irregular heartbeats that require pacemaker or medicines 
• Loss of memory
• Postpericardiotomy syndrome, which includes chest pain and low fever for up to six months

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You will have a follow-up appointment within four to six weeks to get the sutures removed if left in place at the time of discharge.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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