What is Mitral Valve Surgery? Is it dangerous?

Cardiac Valves

Valves situate between cardiac chambers or between cardiac chambers and main veins and they regulate blood flow according to heart’s pumping characteristic. There are 4 valves in the heart. Aortic and mitral valves are on the left side and they pump oxygenic arterial blood to the body and tricuspid and pulmonary valves are on the right side of the heart and they pump venous blood to lungs. Mitral and tricuspid valve’s leaflets hold to cardiac chamber walls with chords named “chorda”. Aortic and tricuspid valves have 3 leaflets whereas mitral and pulmonary valves have 2.

Surgical Valve Diseases

1-2% of people in the world die from Valve diseases. In the recent years there has been new developments in artificial valve technologies therefore effective and permanent surgical treatments has become popular.

Valves allow blood flow, when there is something that blocks this or holds the blood, insufficient pathologies need to be fixed though surgical intervention after a time. Damages on leaflets, chords or annulus tissue around valves may cause valve diseases.

The disease may affect a singular valve or plural valves at the same time. In this case, disease generally starts with one valve and after it damages other valves due to heart’s functioning principles. Valve problem’s main reasons are congenital diseases, rheumatic fever, infections, age-related failures, coronary heart diseases and aortic aneurysm. When valve diseases come to a point where surgery is needed, generally there are both stenosis and insufficiency.

Stenosis: When leaflets become thick or deformed or stick to each other, sufficient blood flow is blocked, these pathologies are called “stenosis”. Chords may also be affected by this at the same time. If blood flow reduces to a critical level, surgical intervention becomes a must.

Mitral Insufficiency: Annular tissue enlargement, deformation in leaflets or chord extension may cause unusual closure of valve and a little blood repasses. If this amount of blood surpasses a certain level, surgical intervention becomes necessary.

Reasons of Mitral Valve Stenosis

• Rheumatic cardiac diseases (joint rheumatism etc. in early ages)
• Severe mitral annular or leaflet calcification
• Congenital mitral valve deformities
• Endocarditis (Valve infection)
• Left atrial thrombus, left atrium tumor
• Metabolic or carcinoid syndromes that cause deformation
• Undergone commissurotomy interventions (mitral valve surgeries)
• Undergone mitral valve replacement surgeries

Reasons of Mitral Valve Insufficiency

• Myxomatous degeneration of mitral valve (degeneration of cartilage)
• Rheumatic cardiac diseases (such as joint rheumatism)
• Effective endocarditis (Valve infection)
• Mitral annulus calcification
• İdiopathic (reason unknown) chorda rupture
• Ischemic (coronary insufficiency-dependent)

Symptoms of Mitral Valve Diseases

Shortness of breath, tachycardia, arrythmia, pain in the chest, fainting, leg swelling, hemoptysis, not being able to lie back may be symptoms of cardiac valve diseases. These symptoms generally co-exist. Distinctness of the symptoms play a key role during surgical decision process.

Diagnostic Procedures

Valve diseases can be diagnosed with echocardiography and angiography. For the patients who don’t need surgical intervention, periodical echocardiographic examinations should be applied. Valve diseases can also be detected by coincidence during the examinations of other cardiac problems.

Mitral Valve Surgery

There are different types of Mitral Valve surgeries. However, in general there are 2 main surgical interventions:

1) Replacement

2)Reconstruction (Repair)

Mitral Valve Replacement: It’s a procedure of replacing the damaged valve with mechanical or biological prosthesis valve. Mechanical valves are generally made off highly solid carbon substance and their surface gets nanometrically slippery so that it allows blood flow easily.

In this way, after the valve surgery thromboses can be prevented. However, no matter how qualified the mechanical valve is, Coumadin (Warfarin), blood thinner medication, use is obligatory. Mechanical valves function without a problem for years if coumadin use is regulated periodically.

Biological valves, on the other hand, are made off calf pericardium (cardiac membrane), horse pericardium. These biological materials are processed in laboratories before they are used for patients. Biological valves tend to degenerate more comparing to mechanic (metal) valves. The body perceives biological valve as a foreign substance and develops an immune reaction towards it. After years, biological valves start to degenerate. This process differentiates from a patient to another. Mitral biological valves are more likely to be degenerated than aortic valves. They function for 5 to15-20 years.

Mitral Valve Repair: If the cartilage structure of valve leaflets is not very degenerated, if there are no calcification or there is a leakage due to cardiac dilatation, mitral valve can be repaired. Repair is the best surgical method for the patient considering its advantages. Patients don’t have to use blood-thinner medication after repair surgeries. The risk of bleeding, emboli and valve infections are nearly zero. Famous cardiac surgeon Alain Carpentier (Paris, France) was a role model for cardiac has been a role model for years and thanks to him this method spread to the world. Many surgeons succeeded lots of surgeries for years with his techniques.

Both mitral valve replacement and repair surgeries can be performed through small incision method. These surgeries are generally applied under the right breast or through sternum with 5cm. incision.

Mitral Valve Surgery success rates are between 97-99%. Risk factors of these surgeries on the other hand are late surgery plan, pulmonary hypertension, rhythm disturbances, emboli in the heart, weakened cardiac beat rate, advanced age and other accompanying illnesses.