Pathology:
The Mitral Valve is located between Upper Chamber (Left Atrium) and Lower Chamber (Left Ventricle). Being a one way valve, it regulates flow of blood in one direction, that is from Left Atrium to Left Ventricle. In certain diseases or genetic disorders, the Mitral Valve malfunctions either blocking blood from flowing towards Left Ventricle from Left Atrium (Mitral Stenosis) or letting it flow back into Left Atrium (Mitral Regurgitation).
Complications:
The following complications are observed in patients with Mitral Valve Defects.
- Mitral Stenosis: As the disease progresses, leaflets of Mitral Valve thicken leading to reduced mobility and narrowing of the opening. This reduces flow of blood from Left Atrium to Left Ventricle leading to increased pressure in Left Atrium and causes back pressure to build up in lungs. Increase in back-pressure due to obstruction to flow of blood in heart and lungs causes Breathlessness. Due to obstruction to flow of blood through Mitral Valve, volume of blood in Left Atrium increases causing it enlarge. As the enlargement becomes significant, Left Atrium is unable to contract. This upsets Electrical Rhythm (Atrial Fibrillation) of the heart causing Palpitation. Due to stagnation of blood in Left Atrium, there is possibility of Blood Clots, which if ejected into the blood stream can cause Stroke.
- Mitral Regurgitation: As the disease progresses or due to infection of the leaflets, Mitral Valve lose its ability to close completely. This results in blood flowing back into the Left Atrium leading to increased back-pressure in the heart and lungs causing Palpitation and Breathlessness.
Treatment:
The usual investigations needed to diagnose and plan treatment for Mitral Stenosis and Mitral Regurgitation are 2D Echo and occasionally Transesophageal Echocardiography (TEE). In patients above 40 years of age, Coronary Angiography is required to identify Coronary Artery Blockages. This condition is corrected by procedure called “Mitral Valve Replacement (MVR)”. The two approaches to corrective surgical procedures for Mitral Valve Replacement (MVR) are:
- Open Surgical Mitral Valve Replacement (MVR)
The chest bone (Sternum) is split vertically to access the heart. The defective Mitral Valve is replaced by an artificial (Prosthetic) valve.
- Minimally Invasive Mitral Valve Replacement (MICS)
A small incision is made through the rib cage is made to access the heart. The procedure requires special instruments and techniques. The defective Mitral Valve is replaced by an artificial (Prosthetic) valve.
The 2 types of Prosthetic Valves available are
- Mechanical Valve: Made from a composite of Pyrolitic Carbon and Titanium, the Mechanical Valve is generally recommended for younger patients below 60 years of age. The Mechanical Valve is durable and lasts longer. As the material used in construction is inorganic, the patient has to consume blood thinners (Anti Coagulants) all through their life as well as regular blood testing (PT/INR), sometimes as frequent as monthly, to assess the thinness (Anti-Coagulation) status.
- Bio-Prosthetic (Tissue) Valve: The Bio-Prosthetic Valve is made up of biological tissue, usually of Bovine or Porcine origin. This valve is recommended for patients ideally above 65 years of age. The Bio-Prosthetic Valve, which as per manufacturers claim lasts 15 to 18 years, is much lesser than the Mechanical Valve. Incase of degeneration of the Bio-Prosthetic Valve, the patient may have to again undergo Mitral Valve Replacement Surgery (Redo Surgery). At the same time, the patient has to consume blood thinners (Anti Coagulants) for just 3 months after the surgery.
Salient Features of Mitral Valve Replacement Surgery
- Irrespective of the type of Mitral Valve used, the patient is able to return to an active and healthy life after receiving the prosthetic valve.
- Patients display significant symptomatic improvement after Mitral Valve Replacement Surgery.
- In some cases, where Coronary Artery blockages are observed along with Mitral Valve malfunctions, both Coronary Artery Bypass Grafting (CABG) & Mitral Valve Replacement (MVR) Surgeries can be performed simultaneously.
Dr. Dhairyasheel Kanase is one of the leading cardiac surgeon in India having performed many complex Mitral Valve Replacement Surgeries with excellent outcomes.
