MITRAL VALVE DISEASES
MITRAL VALVE SURGERY
The heart has four valves. On the left side of the heart are the aortic and mitral valves, and on the right are the tricuspid and pulmonary valves. The aortic and tricuspid valves have three leaflets, the mitral and pulmonary valves have two leaflets. The mitral valve is located between the left atrium and left ventricle.
Diseases can be in a single valve or in multiple valves. The disease that starts in one valve can affect other valves over time.
Causes of heart valve diseases; It is divided into two main groups as congenital or acquired.
Rheumatic Disease is in the first place among the later diseases. It often creates stenosis (Stenosis) in the lids. In cases where leaflets or valves thicken, deform, stick to each other and harden and calcify over time, there is a decrease in the area and opening of the valve that prevents the passage of blood. Stenosis is the name given to this condition. is pathology. Surgery is required if the valve area falls below a critical level.
Insufficiency: As a result of enlargement and relaxation in the hinge (annulus) tissue holding the valves around the valve and deformation or elongation in the structures (chordae) holding the valves, the closing of the valve cannot be fully realized and some opening remains and blood escapes. Surgical intervention is required if the amount of blood escaping back, the enlargement of the relevant parts of the heart, and the extra blood supply to the lungs increase the lung pressure above a certain level. We will examine this issue in detail.
Mitral regurgitation, Mitral Valve Prolapse: CLICK
Symptoms in Mitral Valve Diseases
Shortness of breath is the most common. The effort capacity of patients decreases with time. It is typical for them to complain, “I used to climb four flights of stairs, now I can barely climb two flights of stairs.” In addition, there may be symptoms such as palpitations, rhythm disturbances, chest pain, fainting, swelling in the legs, spitting up bloody sputum (in very advanced cases) and inability to lie down. One of these symptoms is present together with being in the foreground. The severity of the symptoms is important in making the decision for surgery.
Diagnostic Methods
Echocardiography evaluates the structure of the valves, the size of the heart sections, and the performance of the heart. If individuals are in the risk group for Coronary Artery Disease in terms of age and other factors, catheterization and angiography are required for diagnosis.
There is no condition that every valve patient will have surgery. For the mitral valve, stenosis and insufficiency are usually found together.
The narrowing progresses over time. Age and calcification around the lid play an important role in this. Calcium is responsible for calcification. Valve patients who do not require surgery are followed up every six months with echocardiography.
Mitral valve insufficiency is common in patients and even in normal individuals. These are reported as “minimal failure” or “primary failure” in reports. These are also seen in normal individuals up to 7% of the society. There is no rule that individuals will have surgery in the future.
What are Mitral Valve Surgery?
1) Replacement ,
2) There are two options as Reconstruction (Repair).
Mitral valve replacement: The valve is removed and replaced with a mechanical or biological prosthetic valve. Mechanical covers are made of hard carbon material, they have been developed as a result of years of studies and are used with confidence.
It is imperative to always use the drug Coumadin (Warfarin) to prevent clots in mechanical valves. In order to dilute the blood in mechanical valves, an examination called INR should be performed. (See Coumadin video) It is not recommended for patients using Coumadin to become pregnant because it causes developmental damage to the baby. Despite some new blood thinners, sufficient data are not available. These covers are very durable. They work without problems throughout the life of patients.
Biological valves, on the other hand, are generally produced by preparing biological materials such as pig valve, calf or pig pericardium.
Biological valves have a risk of deterioration compared to mechanical valves. With both the response of the immune system, which perceives the biological valve as a foreign substance, and the work against pressure, deterioration in its structure, deformation and degeneration are observed over time. For caps, which used to have a 20% chance of deterioration within 10 years, this rate is gradually decreasing with changes in technology and preparation. Biological valve patients use coumadin for a short time after surgery and then do not use it. This is the most important advantages. Since such caps are not fully covered by SSI in our country, there is definitely a difference. This difference also varies depending on the dollar exchange rate. It is useful for patients to know this.
What is Mitral Valve Repair?
If the main cartilage structure of the mitral valve leaflets is very intact, if there is not much lime, and especially if there is insufficiency due to the expansion of the valve (annulus); repair is possible. In the repair, the expanding frame of the door is narrowed, the excesses in the flaps are removed and the narrowed door frame is strengthened with a metal ring. Repair is an advantageous method as long as the valve is suitable for the patient. Patients do not use Coumadin, the risk of bleeding, clotting (Emboli) and infection is low. In addition to the classical incision, valve surgeries can be performed with incisions under the right breast or under the armpit.
What are the Risks of Mitral Valve Surgery?
The earlier the surgery, the lower the risk. The risk varies between 1-2% in cases of Mitral Stenosis and 2-4% in cases of regurgitation. The most important risk factors are the increase in lung pressure with excess blood in the lungs or the decrease in the contractile function of the heart.
One of the general criteria is to perform surgery without disturbing the heart rhythm. Surgery is more beneficial before a rhythm disorder called Atrial Fibrillation develops. Sometimes this rhythm disorder reduces the functions of the heart by 30%. The rhythm disorder can also be permanent after a certain period of time. It does not improve with surgery. This is very undesirable.
Mitral Valve Replacement with Angio
In recent years, mitraclip in cases of angiography and mitral regurgitation and some valve replacement procedures in mitral stenosis have moved from the experimental stage to clinical practice. Widespread use is not yet available as its results and risks have not been clarified.
KEYWORDS
mitral valve, mitral valve diseases, mitral valve surgeries, mitral valve where, mitral valve repair, valve repair, mitrallip, health, heart, cardiovascular, heart diseases, valve diseases, doctor, prof, serdar akgün
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