Name of the Procedure:

Valvotomy, Mitral Valve; Open Heart, with Cardiopulmonary Bypass
Common Names: Open Heart Mitral Valvotomy, Mitral Valve Repair

Summary

An open heart mitral valvotomy is a surgical procedure used to treat a narrowed mitral valve due to conditions such as mitral stenosis. The surgeon accesses the heart through the chest, and with the help of a heart-lung machine (cardiopulmonary bypass), repairs or enlarges the mitral valve to improve blood flow.

Purpose

This procedure addresses the medical condition known as mitral stenosis, where the mitral valve is narrowed, restricting blood flow from the left atrium to the left ventricle. The primary goal is to restore normal blood flow, alleviate symptoms like breathlessness and fatigue, and prevent complications such as heart failure or atrial fibrillation.

Indications

• Symptoms of heart failure such as shortness of breath, fatigue, and fluid retention.
• Diagnosis of moderate to severe mitral stenosis confirmed by imaging studies.
• Presence of complications like atrial fibrillation or pulmonary hypertension.
• Failure of less invasive treatments such as balloon valvuloplasty.

Preparation

• Fasting for at least 8 hours before the procedure.
• Stopping certain medications as advised by the doctor.
• Pre-surgical assessments including blood tests, echocardiogram, chest X-ray, and electrocardiogram (EKG).

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the chest to access the heart.
3. The patient is connected to a heart-lung machine, which takes over the function of the heart and lungs during the surgery.
4. The surgeon makes an incision in the left atrium to access the mitral valve.
5. The mitral valve is examined and then either repaired or widened using specialized surgical instruments.
6. The heart is closed, and the heart-lung machine is gradually removed as the patient's heart resumes its function.
7. The chest incision is closed using sutures or staples.

Duration

The procedure typically takes about 3 to 5 hours.

Setting

Performed in a hospital surgical suite with specialized cardiac surgery facilities.

Personnel

• Cardiac Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates the heart-lung machine)
• Surgical Assistants

Risks and Complications

• Bleeding
• Infection
• Blood clots leading to stroke or pulmonary embolism
• Irregular heart rhythms (arrhythmias)
• Valve dysfunction or failure requiring further surgery
• Heart attack
• Reaction to anesthesia

Benefits

• Improved blood flow through the heart
• Relief from symptoms like shortness of breath and fatigue
• Reduced risk of complications such as heart failure or stroke
• Enhanced quality of life

Recovery

• Stay in the intensive care unit (ICU) for 1-2 days post-surgery.
• Hospital stay of about 5-7 days.
• Gradual return to normal activities over 6-8 weeks.
• Regular follow-up appointments to monitor heart function.
• Possible restrictions on physical activity during recovery.

Alternatives

• Balloon Valvuloplasty: A less invasive option using a catheter to widen the valve.
  • Pros: Lower risk, shorter recovery.
  • Cons: May not be as effective for severe cases.
• Mitral Valve Replacement: Replaces the valve with a synthetic or biological valve.
  • Pros: Permanent solution.
  • Cons: More invasive, higher risk of complications, longer recovery.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel pain.
• Post-operative pain at the incision site managed with medication.
• Discomfort and tiredness are common during the early recovery period.
• Gradual improvement in symptoms and physical capacity as healing progresses.
• Pain management and support from the healthcare team to ensure comfort during recovery.