Type of Surgery
Information
Last updated: 11/24/2009
Cardiac monitoring is instituted and general anesthesia is provided. The surgeon uses a sternotomy to access the heart and great blood vessels. Anticoagulation is given as cannulae are inserted into the great vessels, femoral vessels, or a combination....
Cardiopulmonary bypass is instituted. The heart is arrested as the cross clamp is applied to the ascending aorta to stop blood flow through the organ. The surgeon opens the heart to visualize the mitral valve. He/she may expose the mitral valve by opening the right atrium and then opening the atrial septum. Another approach requires a large left atrium that can be opened directly, making the mitral valve visible.
Mitral commissurotomy
Mitral commissurotomy is used to repair mitral stenosis associated with rheumatic disease. The commissures—openings between the valve leaflets—are manually separated by the surgeon. Fused chordae tendineae (cords of connective tissue that connect the mitral valve to the papillary muscle of the heart's left ventricle) are separated, along with papillary muscles. Calcium deposits may be removed from the valve leaflets. The left atrial appendage is removed to reduce the risk of future thromboemboli (blood clot) generation.
Chordae tendineae repair
The chordae tendineae can become lengthened or rupture, resulting in mitral valve prolapse. A skilled surgeon repairs the mitral valve structure by placing sutures in the valve leaflets to stabilize the valve structure. Typically the posterior leaflet requires this type of repair.
Annuloplasty
A flexible fabric ring is sutured to the valve annulus to provide support and reconstruction for the patient's valve annulus. The size of the ring is selected to match the patient's own valve size. This repair allows the valve to function normally.
The heart is closed with sutures. Deairing of the heart is performed prior to removal of the cross clamp. When the cross clamp is removed, deairing continues to ensure that no air is delivered to the systemic circulation. At this time a transesophageal echocardiogram (TEE) may be used to test that the valve is functioning correctly and that the heart is free of air. If the surgeon is not satisfied with the repair, mitral valve replacement is performed. Once the surgeon is satisfied that the valve is working correctly, cardiopulmonary bypass is terminated, anticoagulation is reversed, and the cannulae are removed from the vessels. The sternotomy is closed. Permanent stainless steel wires are used to hold the sternum bone together. The skin incision is closed with sutures, and sterile bandages are applied to the wound.
Advertisement
This video includes echocardiogram information from a patient showing severe mitral valve prolapse and actual footage during repair of a mitral valve. This view is from inside the heart that has had all of the blood removed and diverted (not shown).
During a mitral valve repair, the patient's chest is opened along the sternum (A). The heart is connected to a heart-lung machine, and an incision is made into the right atrium, or upper chamber of the heart (B), exposing the mitral valve (C). A section of the valve is removed, and the area is repaired with sutures (D and E). A flexible fabric ring may be stitched to the outside of the valve to strengthen it, in a procedure called an annuloplasty (F). (Illustration by GGS Inc.)
Search
Other Information
Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the left atrium of the 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. 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.
Other Information
In 2006, 2,192 heart transplantations were performed in the United States. There are 257 transplant hospitals in the United States, 135 of which perform heart transplantations. (http://www.unos.org/)
From: Unos.org
Find a Qualified Specialist
Looking for a specialist?
Please enter your zip code.