Overview
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
Definition :
Mitral valve replacement is done when the mitral valve is not working well. The mitral valve is in the left side of the heart. It allows blood to flow from the left upper chamber (left atrium) into the left lower chamber (left ventricle). When the valve is not working well, it may need to be replaced.
Reasons for Procedure :
Healthy heart valves permit one-way flow of blood. Diseased valves either leak, causing back flow, or narrow, restricting flow. In either case, the condition can be life threatening. Sometimes the valve can be repaired. At other times it must be replaced.
Rheumatic fever, infections, and congenital defects are the most common causes of mitral valve problems.
Call Your Doctor :
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Constipation , diarrhea, bloody, or tarry-color bowel movements or stomach pain
- Weight gain (greater than two pounds in two days)
- Worsening of ankle swelling
- Severe headache
- Nausea and/or vomiting
- Cough, shortness of breath or chest pain
- Coughing up blood
- Skin rash, or unusual bruising or bleeding
- Confusion
- Dizzy or lightheaded when standing
- Tingling in hands and feet
- Irregular heartbeat, extremely slow pulse, or fast pulse
- Burning during urination
What causes mitral valve problems?
Mitral valve problems are rarely caused by a birth defect, otherwise known as a congenital condition. More often, simple "wear and tear" may cause part of the valve mechanism to fail. This is called "degenerative disease". This may be related to advancing age, although many young people will have this condition as well. Rheumatic fever may damage the mitral valve causing stenosis or regurgitation. Occasionally the mitral valve is damaged by infection or bacterial endocarditis. Ischemic heart disease (coronary artery disease) can also cause the mitral valve to leak.
What are the surgical options?
Many mitral valves can be repaired, especially if they leak due to degenerative disease. A separate discussion of mitral valve repair will be available through this site. In many cases, however, the valve is too damaged to permit repair and the valve must be replaced with a prosthetic (artificial) valve. Valves damaged by rheumatic disease often must be replaced.
In general terms, there are two types of artificial valves available - mechanical valves made entirely from metal and pyrolytic carbon - or biological valves - made from animal tissues. Each has advantages and disadvantages with respect to durability (how long they will last) and risk of blood clots forming on the valve.
The choice of which type to use should be made by you and your doctors taking the following into consideration:
Your ageOther medical conditionsYour preferences with regard to medications and the risk of reoperationYour lifestyle.
Mechanical Valves :
There are a number of excellent mechanical prostheses available today. All perform equally well. The principle advantage of mechanical valves is their excellent durability. The valves available today simply do not wear out! Their main disadvantage is that blood has a tendency to clot on all mechanical valves. If this happens the valve will not function normally. Therefore, patients with these valves must take anticoagulants (blood thinners) for life. There is also a small but definite risk of blood clots causing stroke, even when taking anticoagulants.
Biological Valves :
There are a variety of biological alternatives for mitral valve replacement. Most are made from pig aortic valves. Their key advantage is that they have a reduced risk of blood clots forming on the valve itself causing valve dysfunction or stroke. The key disadvantage of biological or tissue valves is that they have more limited durability as compared with mechanical valves. They will wear out given enough time. The rate at which they wear out, however, depends on the patient's age.
A young boy might wear out such a valve in only a few years, while the same valve might last 10 years in a middle aged person, and even longer in a patient over the age of 70. Of course, as we grow older we expect that we will not need the valve for as many years as our life expectancy is less. The general consensus is that a tissue valve will not need to be replaced if used in a patient over the age of 70 years.
What Are The Risks Of Surgery?
Your cardiologist and cardiothoracic surgeon can best determine your individual risk of surgery. It will depend on your age, general condition, specific medical conditions, and your heart function.
What Will My Condition Be Like After Mitral Valve Replacement?
After successful mitral valve replacement you can expect to return to your preoperative condition or better, although this may take time. Anticoagulation (blood thinners) with Coumadin is often prescribed for 6 weeks to 3 months postoperatively for those with biological valves, and for life for those with mechanical valves. Once your wounds have healed there should be few, if any, restrictions on your activity. (For more information about your recovery, refer to What to Expect After Your Heart Surgery.)
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