Patient's Guide To Minimally Invasive Mitral Valve Repair
Blood flows into your heart through the inferior and superior vena cava
. It then moves to your lungs in order to pick up oxygen before returning and being pumped out to the rest of your body. As blood moves from chamber to chamber, its passage is regulated by a series of valves. One of them is called the mitral valve (MV).
The MV sits between the upper and lower chambers (atrium and ventricle, respectively) of the left side of your heart. As the upper chamber contracts, the valve's two leaflets open. This allows blood to be pushed through into the lower chamber. When the lower chamber contracts, the leaflets close to prevent blood from flowing back into the atrium. This process works well as long as the MV is functioning properly. Problems occur when the leaflets are diseased.
In this article, we'll explain the disorders that can affect the MV and prevent it from working as it should. We'll also describe the types of mitral valve surgery that can be performed in order to resolve the underlying issues.
Disorders Of The Mitral Valve
The two most common disorders are stenosis and regurgitation. Of the two, stenosis is far less common. A stenotic mitral valve fails to open properly. This is due to its two leaflets having become stiff. The result is that blood cannot pass effectively from the atrium into the ventricle. This causes fluid to back up within the upper chamber and lungs.
Stenosis is almost always due to a sequence of events that begins with rheumatic fever. Because western societies now use vaccinations to prevent this type of fever, stenosis rarely occurs today.
A regurgitant mitral valve fails to close properly. This occurs because the leaflets flop back into the atrium rather than sealing the opening. As a result, blood within the ventricle flows back into the atrium when the ventricle contracts. This can lead to pooling and clotting within the atrium, which in turn, exposes the patient to a risk of stroke.
Types Of Mitral Valve Repair Surgery
Mitral valve repair surgery has traditionally been performed through thoracotomy. The surgeon cuts through the patient's breastbone in order to gain access to the heart. This process requires the patient's heart to be stopped while the surgeon performs the needed repairs. Today, minimally invasive techniques are used.
For a stenotic MV, balloon valvotomy is performed. During this procedure, the doctor will insert a catheter in the groin area and thread it to the right side of your heart. He or she will then create an opening through the wall (i.e. the septum) that separates the two upper chambers. The catheter is equipped with a balloon on its tip. It is guided into the mitral valve where it is inflated. The balloon's inflation enlarges the opening, which allows blood to flow through more easily.
For a regurgitant MV, a surgeon will need to identify which of the two leaflets (posterior or anterior) is diseased. Different approaches are used for each.
A floppy posterior leaflet can be repaired with a procedure called triangular resection. Your surgeon will cut and remove a small, triangular piece of the leaflet from the base of the mitral valve. The two edges are sewn together and an annulus is placed around the perimeter for support.
If the anterior leaflet is floppy, a chordal transfer is usually necessary. This operation is more complex than a triangular resection, but can still be accomplished with minimally invasive techniques. The surgeon will attempt to transfer a few chords from the non-diseased leaflet to provide support for the floppy one. If this is not possible, the chords can be constructed from Gor-Tex. Once the transferred - or new - chords are in place, an annulus is positioned around the mitral valve's perimeter.
Minimally invasive mitral valve repair surgery is becoming more common as the techniques are adopted by a growing number of surgical centers. Consult your physician to discuss whether this approach is available.
by: Elizabeth L Perkins
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