Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. Cardiac surgery is Surgery on the Heart and/or Great vessels performed by a Cardiac surgeon. A cardiac surgeon is a Surgeon who performs Cardiac surgery - operative procedures on the Heart and Great vessels. A stenosis ( Plural: stenoses; from Ancient Greek στÎνωσις "narrowing" is an abnormal narrowing in a Blood vessel The miter valve (also known as the bicuspid valve or left atrioventricular valve) is a dual flap (bi = 2 valve in the Heart that lies between The mitral valve is the "inflow valve" for the left side of the heart. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the left atrium of the heart. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells €”such as nutrients and oxygen—and transports Waste products lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive The four pulmonary veins carry Oxygen -rich Blood from the Lungs to the left atrium of the Heart. The left atrium is one of the four chambers in the Human Heart. After the left atrium fills with blood, the mitral valve allows blood to flow from the left atrium into the heart's main pumping chamber called the left ventricle. In the Heart, a ventricle is a heart chamber which collects Blood from an atrium (another heart chamber that is smaller than a ventricle and It then closes to keep blood from leaking back into the left atrium or lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets.
The techniques of mitral valve repair include inserting a cloth-covered ring around the valve to bring the leaflets into contact with each other (annuloplasty), removal of redundant/loose segments of the leaflets (quadrangular resection), re-suspension of the leaflets with artificial (Gore-Tex) cords. More recently the Alfieri stitch (or "bow-tie") has been adapted to allow percutaneous repair in select patients. Count Vittorio Alfieri ( 16 January 1749 &ndash 8 October 1803) was an Italian Dramatist, considered the "founder In Surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin rather than by using an "open"
Procedures on the mitral valve usually require a median sternotomy, but advances in non-invasive methods (such as keyhole surgery) allow surgery without a sternotomy (and resulting pain and scar). Median sternotomy is a type of Surgical procedure in which a vertical inline Incision is made along the Sternum, after which the sternum itself is divided Laparoscopic surgery, also called Minimally invasive surgery (MIS, bandaid surgery, Keyhole surgery, or pinhole surgery Minimally invasive mitral valve surgery is much more technically demanding and may involve higher risk.
Occasionally, the mitral valve is abnormal from birth (congenital). A congenital disorder is a disease or disorder that is present at birth More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever. Rheumatic fever is an Autoimmune inflammatory Disease which may develop two to three weeks after a Group A streptococcal infection (such as In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Endocarditis is an Inflammation of the inner layer of the Heart, the Endocardium. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease). Ischaemic or ischemic heart disease (IHD or myocardial ischaemia, is a Disease characterized by reduced blood supply to the heart muscle
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A history of mitral valve repair
In 1923 Dr. Elliot Cutler of the Peter Bent Brigham Hospital performed the world’s first successful heart valve surgery - a mitral valve repair. Brigham and Women's Hospital (BWH is the largest Hospital of Longwood Medical and Academic Area, in the Boston, Massachusetts neighborhood of The patient was a 12-year-old girl with rheumatic mitral stenosis. Rheumatic fever is an Autoimmune inflammatory Disease which may develop two to three weeks after a Group A streptococcal infection (such as
The development of the heart-lung machine in the 1950s paved the way for replacement of the mitral valve with an artificial valve in the 1960s. An artificial heart valve is a device which is implanted in the heart of patients who suffer from valvular diseases in their heart For decades after, mitral valve replacement was the only surgical option for patients with a severely diseased mitral valve. Mitral valve replacement is a Cardiac surgery procedure in which a patient’s Mitral valve is replaced by a different valve However, there are some significant downsides to an prosthetic mitral valve. An artificial heart valve is a device which is implanted in the heart of patients who suffer from valvular diseases in their heart Infection of the valve can occur, which is dangerous and difficult to treat. Patients with mechanical heart valves are required to take blood thinners for the rest of their lives which presents a risk of bleeding complications. An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting The artificial mitral valve has an elevated risk of stroke. Finally, artificial tissue valves will wear out - on average lasting between 10 and 15 years, requiring further surgery at an advanced age.
In the past two decades, some surgeons have embraced surgical techniques to repair the damaged native valve, rather than replace it. These techniques were pioneered by a French heart surgeon, Dr. Alain F. Carpentier. Alain Frédéric Carpentier MD PhD (born August 11, 1933 in Toulouse, Haute-Garonne) is a French Heart A repair still involves major cardiac surgery but for many patients presents the significant advantage of avoiding blood thinners and may provide a more durable result. An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting Not all damaged valves are suitable for repair; in some, the state of valve disease is too advanced and replacement is necessary. Often, a surgeon must decide during the operation itself whether a repair or replacement is the best course of action.
There has been great debate about timing of surgery in patients with asymptomatic mitral valve regurgitation. There are minimally invasive (port access) options available pioneered by Hugo Vanerman in Belgium. These methods may be safer, and allow the patient to return to their normal activity much sooner than the standard approach. Robotic mitral valve repair operations are also being tested at some medical centers.
In the 2000s there have been several trials of a newer strategy of mitral valve repair that does not require major cardiac surgery. Through a catheter inserted in the groin, the valve leaflets are clipped together. This technique - percutaneous mitral valve repair - remains under trial, is very specialized and is only available at a select number of hospitals worldwide. In Surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin rather than by using an "open" [1]
See also
- Aortic valve repair
- Cardiac surgery
References
External links
- Mitral Valve Repair at The Mount Sinai Hospital
- Brigham and Women's Hospital Valve Centre
- Co-ordinating centre for trial of percutaneous mitral valve repair in the United States
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