Mitral Valve Repair & Replacement
The mitral valve is between the upper and lower chamber (left atrium and left ventricle), which is on the left side of the heart. It is one of the four valves. It has two doors which are called front and back leaflets (anterior and posterior cusps) to open and close the valve.
Blood from the lungs flows into the upper chamber (left atrium) of the heart. From here it enters the lower chamber (left ventricle). The valve’s function is to control the blood flow between these chambers, and not allow the blood to flow back in the upper chamber, with the help of leaflets. The valve is surrounded by a fibrous ring (called annulus) which maintains the valve’s shape and ensures the leaflets closes properly.
Problem with the Mitral Valve
At times the leaflet enlarges or ruptures because of which the blood leaks in the upper chamber. Mitral valve repair is required when the enlargement or rupture is minimal. Whereas, replacement is required when it is severe. Replacement is also needed in cases where the valve’s opening is narrow by birth, or it hardens (calcifies).
Pre-Surgery
Like any other surgery, general anaesthesia is administered to the patient. In the case of valve replacement, the doctor will advise the patient and their family on the types of valves, their durability and longevity.
The Surgery
A small incision about 2 to 3 inches long is made on the right side of the chest near the breastbone. Muscles in the incision area are separated to approach the upper chamber (left atrium). The second incision is then made in the left atrium to reach the mitral valve. The doctor carefully removes the elongated/ruptured part and sutures (stitch) together, the remaining tissue. The procedure tightens the valve which was loose before the surgery. The doctor then sutures a firm band around the natural ring (annulus), which surrounds the mitral valve to protect it. As the natural ring is no more elastic, the artificial band ensures the repaired leaflets closes properly. The openings are closed and sutured.
In the case of replacement, the complete valve is removed and replaced with a mechanical or biological valve (explained below). The process to approach the mitral valve for the surgery is the same as above.
Valve Types
There are two types of valves, mechanical and biological. A mechanical valve is made from metals such as titanium and carbon. They are long lasting and does not require further maintenance. Since it is an artificial valve, blood clots can develop on them. Therefore, the patient is put on blood-thinning medication for the rest of the life. Biological valve is partially made of animal tissue. They have a life of about 10 to 15 years (in the case of a young patient it is 8-10 years, in the event of an old patient it is 10-15 years). In this type of valve, the patients do not require any blood thinners.
Post-Surgery
The patient will be in the intensive care unit (ICU) for 2 to 3 days after the surgery. There may be two to three tubes attached to the chest to drain fluid. These will be removed within three days of the surgery. Temperature, breathing, pulse, blood pressure will be closely monitored during the stay at the hospital, which will be for less than seven days.
The aortic valve is between the aorta (the main artery through which oxygenated blood is supplied to all the body parts) and lower chamber on the left side of the heart (left ventricle). It is one of the four valves. It has three leaflets like doors which are called cusps, they open and close the valve.
Blood from the lower chamber (left ventricle) is supplied to all the parts of the body through the aorta. The valve’s function is to control the blood flow between the aorta and the lower chamber, and not allow the blood to flow back in the lower chamber.
Aortic Valve Repair & Replacement
Problem with the Aortic Valve
At times one or more cusps are enlarged or ruptured. It causes blood to leak back into the left ventricle. A repair surgery can cure this condition. The valve has to be replaced when the cusps’ enlargement or rupture is severe. Replacement is also required when the valve harden (calcifies), or by birth the valve has only two cusps instead of three, or the valve’s opening is narrow.
Pre-Surgery
Like any other surgery, general anaesthesia is administered to the patient. In the case of valve replacement, the doctor will advise the patient and their family on the types of valves, their durability and longevity.
The Surgery
A small incision about 2 to 3 inches long is made on the right side of the chest near the breastbone. Muscles in the incision area are separated to approach the aorta. At times the doctor may have to split the upper portion of the breastbone to get complete exposure to the aorta. The second incision is then made in the aorta to reach the aortic valve. The doctor will repair the valve if possible.
In the case of replacement, the complete valve is removed and replaced with a mechanical or biological valve (explained below). The process to approach the aortic valve for the surgery is the same as above.
Valve Types
There are two types of valves, mechanical and biological. A mechanical valve is made from metals such as titanium and carbon. They are long lasting and do not require further maintenance. Since it is an artificial valve, blood clots can develop on them. Therefore, the patient is put on blood-thinning medication for the rest of the life. Biological valve is made of animal tissue. They have a life of about 10 to 15 years (in the case of a young patient it is 8-10 years, in the event of an old patient it is 10-15 years). In this type of valve, the patients do not require any blood thinners.
Post-Surgery
The patient will be in the intensive care unit (ICU) for one day after the surgery. There may be two to three tubes attached to the chest to drain fluid. These will be removed within three days of the surgery. Temperature, breathing, pulse, blood pressure will be closely monitored during the stay at the hospital, which will be for about seven days.