Mitral Valve Surgery FAQs

Your heart pumps blood continually to deliver oxygen to every part of your body. The heart is a powerful muscle that pumps blood to the lungs, where it picks up oxygen and delivers it to the rest of the body. When the blood returns to the heart, it’s pumped back to the lungs to pick up more oxygen. For this process to work efficiently, the blood must move freely and in only one direction. The heart’s valves open so blood can move forward, and then close to keep it from moving backward. This process is repeated 5 or 6 billion times during the average lifetime.

The heart has 4 valves. The mitral and tricuspid valves control blood flow between the upper and lower chambers of the heart. Blood passes through the pulmonary and aortic valves on its way out of the heart to carry oxygen to the rest of the body.

Several things can go wrong with heart valves.

They can leak. When a worn-out valve fails to close properly or leaks it’s called prolapsed. Blood flows back-ward (regurgitates) and the heart must work harder to pump the same amount of blood.

They can become narrow due to calcium build up. This narrowing is called stenosis. It keeps the valve from opening completely and reduces the amount of blood that can flow through it.

They can become damaged from an infection. Bacteria that causes rheumatic fever can damage the heart, especially its valves. Heart valves can also be damaged or deformed by an infection called bacterial endocarditis.

They may be defective. This is due to congenital reasons, or they may wear out with age.

A worn out of damaged heart valve can cause some or all of these symptoms:

• Shortness of breath
• Feeling tired during exertion
• A cough, especially at night or when laying down
• An irregular or abnormally fast heart beat
• Swollen feet or ankles
• Pain or tightness in the chest
• Dizziness

Even a relatively insignificant leak in a valve can cause severe symptoms.

After discussing your symptoms and listening to your heart to check for a murmur, the doctor may use a number of different tests to see how it is working.

Electrocardiogram also called an ECG or EKG, can detect a problem with your heart’s rhythm and some problems with how the blood flows.

Ultrasound test also called an echocardiogram makes it possible to watch each heart valve, checking on its structure and thickness, as it opens and closes. Your doctor may order a special type of this test, called a transesophageal echocardiogram.

Radionuclide scan is a special type of x-ray in which a “tracer” chemical is used, produces images of a specific organ, such as the heart. The dye that is injected into the bloodstream during a cardiac catheterization allows the doctor to track the movement of blood and to detect other heart problems that could be causing your symptoms.

Magnetic resonance imaging (MRI) can produce detailed pictures of your heart and arteries and how they function.

During typical open-chest surgery to repair or replace a heart valve, the surgeon makes one large incision in the middle of the chest and breastbone to access the heart. A heart-lung machine takes over the job of circulating blood throughout the body during the procedure, because the heart must be still and quiet while the surgeon operates. Many surgeons are now able to offer their patients minimal incision valve surgery as an alternative to open-chest heart valve surgery.

Minimal incision valve surgery does not require a large incision, or cutting through the entire breastbone. The surgeon gains access to the heart through one of three smaller, less visible incisions (sometimes called ports) made between the ribs or a smaller breastbone incision, and one small incision in the groin. The diseased valve can be repaired or replaced through one or more of the ports between the ribs, with the surgeon looking at the heart directly or through a small, tube-shaped camera.

Studies show a minimal incision approach offers patients a number of advantages, including:

• Less pain
• Lower risk of complications
• Faster recovery and return to normal activity
• A smaller, less visible scar

Patients who have minimal incision valve surgery typically:

• Spend less time in the intensive care unit after surgery
• Return home sooner
• Return to work or normal activities within 4-8 weeks
• Are back at work or resuming normal activities by the eighth week

If you have heart valve surgery, you should expect some scarring. With open-chest surgery, you will have a sizeable scar in the middle of the upper chest (6-12 cm). The smaller incisions associated with a minimal incision procedure (2-6 cm) mean smaller scars, and their locations make them less noticeable.

You will undergo medical tests and different imaging exams to determine:

• Your overall health
• Allergies
• Anatomy
• Best surgical approach

• You will be asked to sign a consent to surgery
• You will be given a specific time to check in to the pre-operating room by your surgeon
• You may be asked to follow certain dietary guidelines
• Your body may need to be shaved
• You will be provided anesthesia as determined by your surgeon

• Pain management
• Rest
• Instructions on when to shower/bathe (usually 10 days to two weeks)
• Dietary guidelines
• Back-to-activity instructions
• Follow-up care as determined by your physician

Get more information about what to expect after mitral valve surgery

The answer depends on many factors, including the approach chosen. Studies on the minimal incision approach show reduced pain compared to open-chest procedures. Ask your surgeon what you should expect for the type of procedure you will receive.

Minimal incision valve surgery has a faster recovery and return to normal activity compared to conventional surgery. Recovery depends on several  factors, but clinical studies show approximately 50 percent of patients return to work and full activity within four weeks.

All patients are encouraged to resume normal activities at their own pace. Many patients report a return to normal activities within a few weeks.