The mitral valve is the valve between the left atrium and left ventricle of the heart. Clean blood coming from the lungs passes through the mitral valve and reaches the left ventricle, which pumps blood to the whole body. When the heart contracts, the mitral valve closes and all the blood is pumped to the body.
Mitral Valve Stenosis
-
It is generally caused by rheumatism fever following a severe, poorly treated respiratory tract infection in childhood.
-
Mitral valve leaflets thicken and calcify. The valves stick together and become unable to move.
-
Normal valve opening is 4-6cm². When the valve opening falls below 1.5cm², there is valve stenosis that requires surgery.
-
Since the valve cannot be fully opened, the blood from the lungs cannot completely drain into the left ventricle. In this case, the pressure in the vessels coming from the lungs to the heart increases. Fluid accumulation in the lungs (pulmonary edema) and shortness of breath occur.
-
If surgery is delayed, irreversible high pressure in the lung vessels and deterioration in heart contraction occur. The surgery becomes very risky or there is no benefit from the surgery (breathing difficulties continue even though the valve is replaced).
Mitral Valve Insufficiency
-
It may occur due to rheumatoid fever, after a heart attack, due to tissue diseases, or due to advanced age.
-
It may be due to the rupture of the filamentous structures (like parachute strings) that connect the mitral valve leaflets to the heart muscle, or if the ring (annulus) where the valves connect to the heart expands, they cannot come close to each other.
-
When the heart contracts, not all of the blood goes to the body. It escapes towards the lungs through the mitral valve, which does not close completely. As the blood pressure in the lungs increases, shortness of breath occurs.
-
In mitral stenosis and insufficiency, the atria of the heart enlarge. As a result, rhythm disorders (atrial fibrillation) occur. Since blood flow in the heart is impaired in this rhythm disorder, a blood clot may form in the heart and this clot can be thrown into the brain, causing a stroke.
Surgical Treatment
-
Mitral stenosis is calcified and begins to open. It is necessary to remove the cover. Instead, a prosthetic mitral valve is placed.
-
The prosthetic valve can be metal (titanium) or it can be a biological valve adapted to the human body by taking animal tissues (cattle or pig).
-
Patients with a metal valve must use a blood thinner (coumadin) for life. Since there is no risk of clotting in the valve in biological valves, there is no need for blood dilution (after the first three months).
-
The purpose of mitral insufficiency is to repair the valve. Since your own valve is preserved, heart functions are better preserved in the long term than valve replacement. Since no prosthesis is used, there is no need for blood thinning treatment.
-
There are various repair operations. Your surgeon should tell you which one is suitable for you based on your disease.
-
If there is a rhythm disorder (atrial fibrillation) accompanying valve disease, an operation to restore normal rhythm (ablation) should be performed in the same surgery.
Small Incision Mitral Valve Surgeries (Minimally invasive surgery)
-
Classically, mitral valve surgeries are performed from the front by cutting the breastbone. A cardiac circulation device is used.
-
In small incision surgeries, mitral valve repair or replacement can be performed through a 4-5 cm incision under the right chest.
-
In the operation performed with the help of a robot or endoscopically, the same procedure is performed as in open surgery.
Read: 0
