Mitral valve repair

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Mitral valve repair is a cardiac surgical procedure performed by a cardiac surgeon to treat stenosis (narrowing) or mitral valve regurgitation (leak). The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it takes oxygen, through the pulmonary vein, into the left atrium of the heart. After the left atrium is filled with blood, the mitral valve allows blood to flow from the left atrium to the central pumping chamber called the left ventricle. Then it closes to keep the blood from leaking back to the left atrium or lungs when the ventricle contracts (squeezing) to push the blood out to the body. It has two folds, or leaflets, known as cusp.

Mitral valve repair techniques include inserting fabric-covered rings around the valve to carry leaflets into annuloplasty, redundant/loose segregation of leaflets (quadrangular resection), and re-suspension of leaflets with artificial cables (Gore-Tex).

Procedures on the mitral valve usually require a median sternotomy, but advances in noninvasive methods (such as keyhole surgery) allow surgery without sternotomy (and result in pain and scarring). Minimally invasive mitral valve surgery is much more technically demanding and may involve a higher risk.

Occasionally, the mitral valve is abnormal from birth (congenital). More often mitral valves become abnormal with age (degenerative) or as a result of rheumatic fever. In rare cases, the mitral valve can be destroyed by bacterial infection or endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease) or non-ischemic heart disease (dilated cardiomyopathy).

Video Mitral valve repair

Histori

In 1923, Dr. Elliott Cutler of Peter Bent Brigham Hospital performs the first successful heart valve operation in the world - a mitral valve repair . The patient is a 12-year-old girl with rheumatic mitral stenosis.

The development of the heart-lung machine in the 1950s paved the way for mitral valve replacement with an artificial valve in the 1960s. Over the next few decades, mitral valve replacement is the only surgical option for patients with severe painful mitral valves. However, there are some significant losses in the prosthetic mitral valve. Valve infection 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 the risk of bleeding complications. Artificial mitral valve has a high risk of stroke. Patients with mechanical heart valves who use warfarin for anticoagulants should undergo long-term anticoagulant therapy. This means they have to go to the clinic and make blood withdrawals in the laboratory, usually once a month, but more often if the levels need to be closely monitored to the therapeutic range. The therapeutic range for most adults with mechanical valves is INR 2.5-3.5. Finally, artificial tissue valves will wear out - an average of between 10 and 15 years, requiring further surgery at an advanced age.

In the last two decades, some surgeons have used surgical techniques to repair the damaged original valve, instead of replacing it. These techniques were pioneered by the French heart surgeon, Dr. Alain F. Carpentier. Improvements still involve major heart surgery but for many patients presents a significant advantage of avoiding blood thinners and can provide more lasting results. Not all damaged valves are suitable for repair; in some cases, the state of the valve disease is too advanced and replacement is required. Often, a surgeon should decide during the surgery whether either repair or replacement is the best course of action. For patients with the most common type of mitral valve disease, called "degenerative" or "myxomatous" mitral valve disease, the rate of repair is very high and long-term resistance is excellent.

There is a great debate about surgery time in patients with asymptomatic mitral valve regurgitation.

The traditional surgical approach to repair mitral valve is a full or partial sternotomy, in which the surgeon cuts the breastbone in the center of the chest to access the heart. There is a minimally invasive option (port access) pioneered by Hugo Vanerman in Belgium. The minimally invasive approach does not involve chest bone cutting, but instead uses multiple incisions on the side of the chest and legs. The cardiac surgeon does not agree on the relative merits of sternotomy versus the minimally invasive approach. Minimally invasive approaches can produce less prominent scars, useful for very obese patients, and allow patients to return to normal activity faster than sternotomy. But some cardiac surgeons believe that unless performed by the most experienced heart centers, minimally invasive surgery may involve longer time on the bypass machine, lower repair rates, and higher stroke risk (although still low). A heart surgery professor said, "I think the only benefit is for cosmesis for the patient and the benefits are for marketing and fostering our practice for ourselves because it is a good way to cultivate one's practice."

Mitral mitral valve repair surgery is also used throughout the United States.

In the 2000s there were several experiments of a new mitral valve repair strategy that did not require major cardiac surgery. Through a catheter inserted into the groin, the valve sleeve is cut together. This technique - improved percutaneous mitral valves - is available in Europe but is still in clinical trials in the United States. This is a very specialized technique available only in selected hospitals. Preliminary trial results indicate that this may be a beneficial approach for patients at high risk of conventional surgery.

In early January 2000, a team of doctors at the "Instituto de CardiologÃƒÆ'a y CirugÃƒÆ'a Cardiovascular" in La Habana, Cuba had beaten or replaced the mitral valve of the heart. The mitral heart valve replacement technique that defeats is as safe as the captured heart technique, and is the recommended alternative to captured heart techniques. The analogy between these two techniques is similar to fixing or replacing a leaking kitchen faucet valve with or without a home water flow, respectively.

Maps Mitral valve repair

References

Transapical Beating-Heart Mitral Valve Repair With an Expanded ...

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Mitral valve repair

Minggu, 15 Juli 2018