Mitral valve repair

Mitral valve plasty is performed with pathologies of this part of the heart, which cannot be cured by conservative methods. Reconstruction of the valve allows you to restore all its functions, prevent heart failure, and save the patient’s life. During the operation, plastic constructions are used to fully rehabilitate the heart and avoid repeated problems with the valve. The procedure is characterized by its own characteristics of the conduct, the rules of preparation and recovery.

Why do we need plastic

The mitral valve is the part of the heart that separates the left atrium from the left ventricle. It ensures the consistent movement of blood inside the heart muscle. This part of the body may change due to congenital anomalies or acquired pathologies. Among the acquired causes, rheumatic heart disease, infections, and chest injuries are considered the main ones.

Pathologies lead to a narrowing of the valve lumen, this is called stenosis. At the same time, the blood circulates poorly in the heart chambers, the right ventricle is overloaded. As a result, the patient is threatened with disability and even death.

Mitral valve insufficiency indicates insufficient closure of its walls. This leads to the fact that the blood in the pulmonary artery does not flow well and does not linger. Such a picture also threatens the patient’s life with its consequences. If diseases are detected in the early stages, they can be cured conservatively, without surgical intervention.

The problem is that at the first stages such pathologies are difficult to determine. The patient feels difficulty in breathing, rapid fatigue, but is unaware of the problem. In the later phases of pathogenesis, it is possible to restore the work of the mitral valve only through surgery.

Plastic involves minimally invasive operations using an endoscope, and abdominal surgery. The type of surgical technique is chosen depending on the clinical picture: simple tasks can be solved by endoscopy, for complex situations, an opening of the sternum is necessary. The scope of the surgeon’s work also depends on the disease and its stage.

Most often, the operation is accompanied by the installation of a support ring or half ring. These designs are selected individually and sewn to the valve itself. Thanks to them, the work of the heart is normalized, the risk of re-stenosis or insufficiency is reduced.

If it is impossible to save the valve leaflets during plastic surgery, prosthetics are performed. Sometimes the motility of the valves is impaired due to secondary chords. If they are too short or thickened, they are reconstructed in such a way as to restore the mobility of the valves. Against the background of mitral valve plasty, most of the problems in this area are solved. Despite the complexity and responsibility of the procedure, her forecasts are positive. Most patients return to normal life without complications.

Indications and contraindications

The indications for the procedure are heart failure in combination with impaired valve function. Symptoms of such a problem are:

• limb edema. Most often, the legs swell, but in some cases the same phenomenon occurs with the hips, genitals, and abdomen;
• breathing difficulties. As a rule, this is shortness of breath, sometimes there may not be enough air, pain when breathing in the chest area;
• pressing and throbbing pain in the chest;
• blue lips, gray skin, “bruises” under the eyes;
• exacerbation of symptoms during exercise.

Such signs indicate a developing disease, in the early stages the problem may not manifest itself in any way. Based on the patient’s complaints, the doctor prescribes several types of diagnostics, then clarifies the diagnosis. If a serious violation in the mitral valve is confirmed, the type of surgical intervention is discussed.

Reconstruction of the heart is a difficult task, so it is carried out only if other methods do not help the patient. To prescribe plastic surgery, the attending physician prescribes a series of examinations to the patient to make sure that such manipulations are necessary. In mild forms of the disease, medication is most often used. Also, other types of therapy are sought if the patient has severe kidney and liver diseases, acute infections, pneumonia, stomach ulcers, diabetes mellitus, poor blood clotting, sepsis.

Mitral plasty is prohibited for people who have just had a stroke and extensive myocardial infarction.

If mitral plasty is necessary, doctors weigh all the risks. Even against the background of some contraindications, an operation can be performed if it is designed to save the patient. Before the appointment of this procedure, it is necessary to undergo training.

Patient preparation

Proper preparation is essential for a successful reconstruction. It also reduces the risk of complications during and after surgery. The preparatory stage is individual for each individual case. The doctor, based on the medical history, prescribes a diet for his ward, gives additional recommendations on the level of stress and rest. In addition, further research is required:

• consultation with a cardiac surgeon;
• blood and urine tests;
• blood chemistry;
• chest x-ray.

For a more detailed examination of the heart and its parts, the patient can undergo more modern techniques. For example, angiography shows blood circulation in every part of the body, it determines exactly where the blood flow is disturbed. Computed tomography is becoming more and more popular among doctors, as it provides more information. CT allows you to consider both blood circulation and the structure of the organ itself, to determine the whole range of problems.

For some categories of patients, there are additional preparation rules:

1. Those who are diagnosed with an arrhythmia are treated to normalize their heart rhythm.
2. In heart failure, the patient is prescribed a diet that reduces the sodium content. Diuretic therapy is added to the therapeutic diet, tablets, teas, infusions are prescribed.
3. Cardiogenic shock is considered a relative contraindication for mitral valve repair. Therefore, before the operation, the patient must undergo rehabilitation.

The day of the reconstruction is scheduled when the patient is fully prepared. It is determined in the hospital 1-3 days before the scheduled date in order to have time to diagnose. It is forbidden to eat 6-8 hours before the operation. To calm the ward, the doctor explains to him how such a procedure is done and why it is needed.

Operation technique

Plastic surgery is carried out only in a hospital, in an office specially equipped for the operation. If it is carried out using an endoscope, there will be monitors in the room to monitor the process. First, the patient is taken for premedication, sedatives and hypnotics are injected into the vein. After falling into sleep, the plastic itself begins.

The surgeon makes an incision on the front wall of the chest, then the breast bones. Layers open access to the heart. A heart-lung machine (AIC) is connected. This device will simulate the work of the lungs, saturating the blood with oxygen while manipulations are being carried out on the heart. Tubes from the AIC are connected to the chambers of the heart, the blood will flow to it, be saturated with oxygen and disperse throughout the body. Then the surgeon begins the main stage of work, it will depend on what exactly happened to the valve.

With mitral insufficiency, the so-called annuloplasty is performed. A plastic ring is placed near the valve opening to restore the lumen and normal blood flow.

The sashes can be connected manually – this is suture plastic. If stenosis is diagnosed, a commissurotomy is needed. This is the manual separation of the fused leaflets in the valve. Stenosis surgery is also performed without connection to the AIC, through a small hole between the ribs on the left side. During the procedure, the patient’s condition is monitored using medical equipment. Blood pressure and respiration are constantly measured. When all work is completed, the AIC is turned off, the surgeon sews up the opening sites in layers. External seams are treated with an antiseptic, a tight bandage is applied. Before taking the patient out of the operating room, check his condition again.

In the first days after the operation, the patient is constantly monitored by doctors. He stays in the hospital for another 5-7 days, depending on the complexity of the operation and the speed of rehabilitation. In the first 1-2 days, bed rest and diet are indicated.

Activity is gradually restored under the supervision of a doctor. Then the operated patient is discharged, medications are prescribed for rehabilitation and a scheduled examination by a cardiologist and a general practitioner.

Simple violations of the mitral valve are solved by minimally invasive techniques. Several small incisions are made in the chest, into one of which an endoscope is placed – a device with a micro-camera. The surgeon performs the operation without a band opening, so after such manipulations the patient undergoes rehabilitation faster.

Recovery after plastic surgery

Surgical interventions on the heart require gradual rehabilitation. In the first month after plastic surgery, it is recommended to treat the whole body very carefully: give up bad habits, follow the prescribed diet, and avoid stress.

During this period, you need to exclude too salty, fried, fatty. Also, drinking plenty of water additionally loads the cardiovascular system, you should try to drink no more than 1,5 liters of water per day. Alcohol is completely excluded.

You need to have scheduled checkups. The doctor will evaluate the effectiveness of plastic surgery and the patient’s condition, adjust the treatment. If in the postoperative period the state of health worsens, this is the reason to call an ambulance or come to an unscheduled appointment. Physical activity should be reduced, sometimes go for leisurely walks, breathe fresh air.

In most cases, such an operation ends successfully for the patient. Over time, all heart functions are restored, and a person can return to an active lifestyle, which is confirmed by reviews.

After the first 4 weeks, an examination is scheduled to ensure the success of the procedure. To do this, you need to undergo an ultrasound of the heart, cardiography, urine and blood tests. In the first year after plastic surgery, the patient visits the doctor every month, then twice a year if there are no complaints.

Where do these operations take place?

Mitral plasty is done only in large regional centers, in the cardiology departments of clinics or specialized centers. The cost of such a service is quite high, the price of mitral valve repair is formed depending on the range of work, the qualifications of the surgeon, the status and pricing policy of the clinic.

On average, such an operation will cost $ 3, the cost includes hospital stay, diagnostics, and surgery. Reconstruction services are also offered by clinics in Europe, where such a service will cost an average of 500 euros.

Consequences of plastic surgery

Like any surgery, plastic surgery is associated with risks. Among the negative consequences, infection, thromboembolic complications, and bleeding are possible. To prevent such consequences, drug prophylaxis is prescribed.

The wound needs constant supervision in the initial postoperative period. Despite the complexity of such manipulations, the prognosis for them is positive.

Soon, life after plastic surgery returns to normal, the symptoms of the disease disappear: shortness of breath, rapid loss of strength, pain. Reviews of cardiac surgeons note that in patients after such a reconstruction, life expectancy increases, the risk of heart attacks and malformations decreases.