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Mitral Valve Treatment

Mitral Valve Treatment

It refers to medical interventions performed to correct or treat dysfunction of the heart valves. Mitral valveIt is a valve located between the left atrium and left ventricle in the heart. When the heart muscle contracts, it opens and allows blood to pass from the left atrium to the left ventricle.

The valve then closes and prevents blood from flowing backwards, allowing blood to be pumped throughout the body. Treatment can target two main problems. Valve insufficiency (regurgitation) and valve stenosis (stenosis). In case of valve insufficiency, the valve cannot close completely and blood flows backwards. In case of valve stenosis, the valve is narrowed and blood flow is restricted.

Treatment can be carried out by various methods:

In mild cases of valve insufficiency, medications are used to relieve symptoms. These medications generally aim to reduce burden, regulate blood pressure, and control fluid accumulation. In cases of severe valve insufficiency or stenosis, surgical intervention may be required. Mitral valve Repair or replacement operations fall into this category.

In repair, the existing valve is repaired, while in replacement, the damaged valve is replaced with an artificial one. Surgical treatment is usually applied for more serious cases. In some cases, minimally invasive techniques can be used for treatment. These techniques provide treatment using smaller incisions and less invasive approaches compared to open heart surgery.

With developing technology, treatment can also be performed using transcatheter methods. In these methods, catheters are generally entered through a small incision in the groin or chest area. Then the artificial valve is placed. This approach may allow the patient to recover more quickly without being under general anesthesia.

In Which Situations Is Mitral Valve Treatment Applied?

Valve insufficiency is a condition in which blood flows backwards due to weakening of the structure or muscles. If left untreated, it can prevent it from functioning efficiently. In advanced cases, surgical repair or replacement may be required.

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Mitral valve Stenosis is a condition in which blood flow is restricted as a result of hardening or narrowing of the valve structure. This may cause the muscle to exert more effort. Treatment options such as surgical valve repair or prosthetic valve implantation may be considered.

Cardiomyopathy describes conditions in which the muscle becomes diseasedly enlarged or thickened. This condition may affect function and need to be treated. Problems can lead to heart failure over time.

In case of heart failure, it cannot pump enough blood to the body. This condition can be treated with medications, lifestyle changes, and sometimes surgery. Infections can affect valve structure. Serious infections may require surgical intervention.

Mitral valve Treatment is determined depending on the patient's condition, symptoms, and the severity of the problem. The treatment approach is evaluated by cardiologists and cardiovascular surgeons. Early diagnosis of the disease and regular follow-up can help make treatment options more effective.

Healing Process Stages in Mitral Valve Treatment

The first stage is to evaluate the patient's symptoms, review their medical history, and perform a physical examination. Additionally, the severity and type of the valve problem is determined through examinations and imaging tests.

Mitral valve If the problems are mild and the symptoms are mild, treatment with medications is preferred. These drugs are used for purposes such as regulating heart rhythm, dilating blood vessels and reducing fluid accumulation.

If the problem is serious and symptoms are worsening, surgical intervention may be necessary. Surgical options may include valve repair or valve replacement. The surgical recovery process may vary depending on the patient's general health condition and surgical method.

After surgical intervention, the patient may need to be monitored in intensive care or normal care. During this process, the patient's heart rhythm, blood pressure and general health condition are closely monitored. Recovery time varies depending on the type of surgical intervention, the patient's age, general health status and risk of complications.

After surgical intervention, patients usually undergo a rehabilitation process. This process may include gradually increasing physical activity, medication adjustments, and lifestyle changes. The time it takes for patients to fully recover may vary depending on the complexity of the surgical intervention and individual patient factors. Treatment can be a long-term process.

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Patients should continue regular doctor check-ups after surgery. During these check-ups, heart function, valve function and general health status are monitored. Adjustments can be made to treatment and medication regulations when necessary.

There is an important point to remember. Mitral valve treatment of problems The approach may vary depending on the patient's condition and the severity of the valve problem. Therefore, a customized treatment plan needs to be created for each patient.

What is Mitral Stenosis and How is it Operated?

What is Mitral Stenosis? Mitral valve surgery is performed by repairing or replacing the mitral valve itself or the ring. Thanks to the experience in heart valve surgeries for many years, artificial valves have been developed and have also contributed to the development of surgical techniques. The most preferred metallic heart valves today are bi-leaflet carbometal structures and although they require anticoagulants, they are long-lasting. In addition, biological valves made of bovine or porcine pericardium have been developed for those who cannot use anticoagulants, especially the elderly or those considering pregnancy. Mitral valve replacement or repair had been performed with sternotomy for many years. Due to the complications of sternotomy, mitral valve surgeries began to be performed with anterolateral thoracotomy in the 1990s in the world and the incisions were gradually reduced. In 1997, we first started performing our surgeries in our country by converting them to a subaxillary incision and contributed to the national and international literature in series. Although there is no difference in the surgical technique, the entry technique has proven to be advantageous in terms of bleeding, infection and early return to daily life. It reduces complications especially in patients with diabetes, rib cage disorders, kidney failure and obesity. In addition, the small size of the incision and its location on the side are also important from a cosmetic perspective.
On the other hand, the entry point of the surgery provides excellent visibility and access, especially in terms of mitral valve exposure. This is another factor that reduces complications. If both mitral and aortic valve replacement is required due to the different entry elevations, Aortic and mitral valve (double valve) surgery should not be performed with this technique. In such cases, the anterior incision, ministernotomy, is more useful and does not cause any entry site complications.

Technical :
 The patient is placed on the left side of the chest under double lumen intubation and general anesthesia; that is, the anterolateral thoracotomy position is given with the chest right side up. A vertical 6 cm incision is made over the intersection of the subaxillary line and the right breast line, and the pectoralis major and pectoralis minor are incised. without cutting the musclesdissected and retractor placed, thorax is entered through 4th intercostal space and right lung ventilation is closed or if not tolerated tidal volume is decreased. Pericardium is opened and its leaves are hung on the chest wall. Aorta, right and left atrium are clearly seen. After turning the aorta with pedicle, it is suspended and aorta and right auricle, right atrium are easily cannulated. Patient is connected to heart lung pump, extra-corporeally transferred, ventilation is stopped and x-clamp is placed on aorta. Cardiac arrest is provided by applying cold blood cardioplegia and topical cold serum physiological. Left atrium is opened and mitral valve image is clear. Left atrium is closed after repair or replacement. Patient is warmed, heart is defibrillated if necessary, after working, pump is stopped by decreasing flow. The heart is easily decannulated. After bleeding control, a single chest drain is placed in the thorax (drain placement is important to avoid pain), the ribs are approximated, and the muscles and subcutaneous tissue are closed according to the procedure. Postoperative follow-up is the same.

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While this intervention technique can be applied to any patient, it is only In some cases it should not be preferred. These :

Those with advanced lung problems
  1. Those over 75 years of age,
  2. Double valve replacement (Aortic and Mitral) required,
  3. It should never be applied to patients requiring aortic valve surgery for the second time.
In addition, the mitral valve will be operated for the second and third time.
It is an ideal method for surgeries.

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