Wockhardt Hospitals Blog

The Mitral Valve is located between the left Atrium and the left ventricle of the heart. It acts as a one way door that allows blood flow from the left Atrium to the left ventricle and prevents it from flowing back into the chamber as the heart pumps blood through the Aorta to the rest of the body.

Damage to the Mitral valve affects the normal flow of blood from the lungs to the left Atrium and to the left ventricle. The blood may flow in a reverse direction back into the lungs which could lead to various respiratory problems and several other complications or there could be obstruction to the flow of blood from Left Atrium to Left Ventricle.

The causes for Mitral Valve Prolapse are classified into congenital and acquired. The acquired causes are categorized as: 1) rheumatic heart disease and 2) degenerative heart disease.

Rheumatic heart disease is a condition in which permanent damage to heart valves is caused by rheumatic fever. The heart valve is damaged by a disease process that generally begins with a strep throat caused by streptococcus a bacteria that may eventually cause rheumatic fever. Symptoms of rheumatic fever are fever, swollen, tender, red and extremely painful joints - particularly the knees, ankles, elbows, or wrists, nodules over swollen joints, red, raised, lattice-like rash, usually on the chest, back, and abdomen, uncontrolled movements of arms, legs, or facial muscles weakness and shortness of breath. The symptoms of rheumatic fever may resemble other bone disorders or medical problems. You need to consult your physician for a diagnosis.

The symptoms related to mitral valve failure progresses slowly, however in certain cases the patients don’t experience most symptoms until the disease is in an advanced stage, and there are also cases where the patient does not experience any symptoms at all.

The general symptoms include chest pains, shortness of breadth, difficulty in breathing, unusual heart heartbeat and fatigue.

Diagnosis is often based firstly on the symptoms of the patient. A skilled doctor may detect a murmur in the heart beat during a regular health checkup. There are a number of tests that can help diagnose the disease.

Electrocardiograms (ECG) – gives a complete record of the electrical activities of the heart, any abnormalities of the electrical impulses of the heart shows up in this test
Echocardiograms – gives the doctor graphic representation of sound waves that are bounced of the heart to detect any abnormalities in the valves of he muscles of the heart.

Cardiac Catheterization – where a dye is injected into the blood stream and an x ray is taken that shows the direction of blood flow.

Surgery to replace or repair the mitral valve is often the best option. However if the damage is beyond repair the total replacement is the only other option. Mitral valve replacement surgery is performed to replace the damaged or diseased valve with an artificial one. The artificial valve may be made of metal and pyrolytic carbon (Synthetic) or it may be derived form biological tissue (Biological).

Bangalore, March 26, 2009: Wockhardt Hospitals Bangalore set yet another benchmark in cardiovascular surgery with one of its consultants Dr. Ganeshakrishnan Iyer, Consultant Cardio Vascular Surgeon,Wockhardt Hospitals performing a Mitral Valve Replacement surgery through Minimally Invasive Endoscopic Technique called the Minimal Thoracotomy Approach. The most important benefits being reduced surgical trauma and a shortened hospital stay.

Two patients were operated through this method with small incision in the right side of the chest measuring 3-4 inches as against the conventional midline sternotomy where the incision is in the front of the chest and measures about 12-14 cms. The rarely used minimally thoracotomy incision can confer the advantages of a smaller surgical wound, reduced blood loss, decreased risk of infection, shorter ICU stay, early discharge, decreased postoperative pain and a smaller cosmetically more acceptable postoperative scar.

T. Ashokan, 46 year old gentleman from Vellore was suffering from exertional dyspnea (breathlessness on exertion) for the last 4-5 years. He is a known case of Rheumatic Heart Disease (RHD) and his echocardiography showed severe mitral stenosis. After diagnosis he was advised for a Mitral Valve Replacement. Mr. Ashokan was admitted at Wockhardt Hospitals and underwent Minimally Invasive Endoscopic Mitral Valve Replacement. His post operative recovery was uneventful and recuperation has been very speedy.

Mrs. Ana Fernandes a 52 year old lady from Goa was suffering from breathlessness on exertion. She is a known case of rheumatic heart disease and her echo report revealed severe mitral stenosis and mild mitral regurgitation and was advised for a Mitral valve replacement surgery. She was admitted at Wockhardt Hospitals and underwent Minimally Invasive Endoscopic Mitral Valve Replacement. Her post operative recovery has also been uneventful and speedy recovery is seen.

Traditionally Mitral valve replacement is an open heart procedure performed by cardiothoracic 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, and into the heart through the mitral valve. When it opens, the mitral valve allows blood to flow into the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets. Occasionally, the mitral valve is abnormal from birth (congenital). More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever.

In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease). Often the mitral valve is so damaged that it must be replaced. Through this new and advanced minithoracotomy method the heart is approached between the ribs, providing the surgeon access to the mitral valve. There is no sternal incision or spreading of the ribs required for this surgical technique. The surgeon inserts special surgical instruments through the incision to perform the valve repair.