Complex Mitral Valve Repair

The heart, our body's tireless worker, has a crucial part named the mitral valve. This valve is like a door that opens to let blood flow into the main pumping chamber of your heart. But sometimes, this valve doesn't work as it should. This is called mitral valve disease, and it can cause big problems for your heart and for your health. When the mitral valve is really sick, doctors have to step in and fix it. This operation is known as a complex mitral valve repair. In this blog, we will dig deeper into what the mitral valve does, what happens when it gets sick, and how doctors fix it.

Understanding the Mitral Valve

The mitral valve is like a double-door system, composed of two flap-like structures, called leaflets, attached to the inner wall of the heart. These leaflets open wide to allow blood to flow from the left atrium (upper chamber) into the left ventricle (main pumping chamber) of your heart. Once the blood has passed, the leaflets swing shut to prevent the blood from flowing back into the atrium.

However, like a door hinge that rusts over time or a lock that misaligns, the mitral valve can also face issues. Two main issues often arise: mitral valve regurgitation and mitral valve stenosis. Mitral valve regurgitation is like a door that doesn't close properly, allowing blood to leak backward. On the other hand, mitral valve stenosis is akin to a door that doesn't open fully, restricting the flow of blood. Both conditions force the heart to work harder, leading to potential heart complications.

When is Complex Mitral Valve Repair Recommended?

Complex mitral valve repair is usually suggested by doctors when medications and lifestyle changes are no longer enough to manage the symptoms or potential complications of mitral valve disease. It is important to note that patients with severe mitral regurgitation can be asymptomatic but may still require surgery to  improve long term survival. Indications for this complex surgery might include severe mitral valve stenosis or regurgitation, symptoms such as fatigue, shortness of breath, lightheadedness, or chest pain, and evidence of deteriorating heart function. In addition, if the left ventricle of the heart is enlarging or weakening, or if there are signs of pulmonary hypertension (high blood pressure affecting the heart and lungs), doctors usually consider these as clear signals that a complex mitral valve repair is crucial. However, each case is unique, and the decision for surgery is always individualized based on a patient's overall health, the nature of their valve disease, and the risks associated with surgery.

What Happens During a Complex Mitral Valve Repair?

During a complex mitral valve repair, the patient is first placed under general anesthesia. The surgeon makes an incision in the chest to access the heart, and a heart-lung machine is used to maintain circulation while the heart is stopped for surgery.

The surgeon then examines the mitral valve. In cases of regurgitation, the valve may be tightened by removing a small section of one or both leaflets, and then the leaflets are sewn back together.

This procedure is known as quadrangular resection. If the leaflets are too floppy, a ring may be sewn around the annulus of the valve to tighten it, a procedure known as annuloplasty. In cases of stenosis, the surgeon may need to separate the leaflets if they have fused together or remove calcium deposits that are restricting the movement of the leaflets.

Following the repair, the heart is restarted, and the surgeon observes the function of the mitral valve to ensure that it is working properly. If the repair is successful, the heart-lung machine is disconnected, and the incision is closed. The patient is then moved to the intensive care unit for close monitoring during the initial recovery period. The total time for the surgery can range from 2 to 4 hours, depending on the complexity of the valve disease and any additional procedures that may be needed.

Recovery and Rehabilitation After Complex Mitral Valve Repair

Postoperative recovery from complex mitral valve repair is typically a gradual process that requires careful monitoring and rehabilitation. Initially, patients will remain in the intensive care unit for close observation. As their condition stabilizes, they will be moved to a regular hospital room. The total hospital stay usually lasts about 4 to 5 days, depending on the patient's overall health and recovery progress.

During this time, rehabilitation begins with gentle physical activity such as sitting up, standing, and eventually walking around the hospital room. Healthcare professionals will also provide guidance on managing pain and healing surgical wounds. Breathing exercises are often recommended to prevent lung complications and improve respiratory function. 

After hospital discharge, the rehabilitation process continues at home or at a skilled nursing facility. Patients usually need to restrict their physical activities for several weeks, gradually increasing their activity levels under the guidance of a physical therapist or cardiac rehabilitation specialist. Regular follow-up visits with the healthcare team are crucial during this time to monitor heart function, adjust medications, and address any potential complications.

Over time, most patients can expect to return to their normal activities, although they will need to commit to a heart-healthy lifestyle that includes regular exercise, a balanced diet, and adherence to prescribed medications. Regular cardiac check-ups will be a part of life going forward. Successful recovery from complex mitral valve repair can significantly improve the quality of life, relieve symptoms of mitral valve disease, and reduce the risk of future heart complications.

Conclusion

Complex mitral valve repair brings numerous benefits to patients suffering from severe mitral valve disease. Patient should seek out an experienced surgeon in mitral valve repair techniques as mitral valve repair has a much better result in life expectancy than mitral valve replacement, especially for mitral regurgitation. The operation effectively alleviates uncomfortable symptoms like fatigue, shortness of breath, lightheadedness, and chest pain, improving the patient's quality of life. It also reduces the workload of the heart by ensuring that blood flows efficiently, thereby reducing the risk of heart complications. In the long term, a successful recovery from the operation allows patients to return to their normal activities, provided they commit to a heart-healthy lifestyle. Regular cardiac check-ups post-surgery also ensure ongoing monitoring and optimal heart health. Consequently, complex mitral valve repair is a crucial intervention that can significantly improve the health and lifestyle of patients with mitral valve disease.

Learn More About Cardiac Care at Broward Health