Blood flows into your heart through the inferior and superior vena cava. It then moves to your lungs in order to pick up oxygen before returning and being pumped out to the rest of your body. As blood moves from chamber to chamber, its passage is regulated by a series of valves. One of them is called the mitral valve (MV).

The MV sits between the upper and lower chambers (atrium and ventricle, respectively) of the left side of your heart. As the upper chamber contracts, the valve’s two leaflets open. This allows blood to be pushed through into the lower chamber. When the lower chamber contracts, the leaflets close to prevent blood from flowing back into the atrium. This process works well as long as the MV is functioning properly. Problems occur when the leaflets are diseased.

In this article, we’ll explain the disorders that can affect the MV and prevent it from working as it should. We’ll also describe the types of mitral valve surgery that can be performed in order to resolve the underlying issues.

Disorders Of The Mitral Valve

The two most common disorders are stenosis and regurgitation. Of the two, stenosis is far less common. A stenotic mitral valve fails to open properly. This is due to its two leaflets having become stiff. The result is that blood cannot pass effectively from the atrium into the ventricle. This causes fluid to back up within the upper chamber and lungs.

Stenosis is almost always due to a sequence of events that begins with rheumatic fever. Because western societies now use vaccinations to prevent this type of fever, stenosis rarely occurs today.

A regurgitant mitral valve fails to close properly. This occurs because the leaflets flop back into the atrium rather than sealing the opening. As a result, blood within the ventricle flows back into the atrium when the ventricle contracts. This can lead to pooling and clotting within the atrium, which in turn, exposes the patient to a risk of stroke.

Types Of Mitral Valve Repair Surgery

Mitral valve repair surgery has traditionally been performed through thoracotomy. The surgeon cuts through the patient’s breastbone in order to gain access to the heart. This process requires the patient’s heart to be stopped while the surgeon performs the needed repairs. Today, minimally invasive techniques are used.

For a stenotic MV, balloon valvotomy is performed. During this procedure, the doctor will insert a catheter in the groin area and thread it to the right side of your heart. He or she will then create an opening through the wall (i.e. the septum) that separates the two upper chambers. The catheter is equipped with a balloon on its tip. It is guided into the mitral valve where it is inflated. The balloon’s inflation enlarges the opening, which allows blood to flow through more easily.

For a regurgitant MV, a surgeon will need to identify which of the two leaflets (posterior or anterior) is diseased. Different approaches are used for each.

A floppy posterior leaflet can be repaired with a procedure called triangular resection. Your surgeon will cut and remove a small, triangular piece of the leaflet from the base of the mitral valve. The two edges are sewn together and an annulus is placed around the perimeter for support.

If the anterior leaflet is floppy, a chordal transfer is usually necessary. This operation is more complex than a triangular resection, but can still be accomplished with minimally invasive techniques. The surgeon will attempt to transfer a few chords from the non-diseased leaflet to provide support for the floppy one. If this is not possible, the chords can be constructed from Gor-Tex. Once the transferred – or new – chords are in place, an annulus is positioned around the mitral valve’s perimeter.

Minimally invasive mitral valve repair surgery is becoming more common as the techniques are adopted by a growing number of surgical centers. Consult your physician to discuss whether this approach is available.

Find the right doctor for mitral valve repair. Check out Health Facts. Early diagnosis can lead to successful results.

Your heartbeat is produced and regulated by a group of cells within your right atrium called the sinoatrial node. This node generates electrical signals that normally spread throughout the surface of your atria before traveling to the atrioventricular node. As these signals traverse the atria, they cause them to contract. This is part of your heart’s normal beating mechanism.

Millions of people suffer a type of arrhythmia called atrial fibrillation (Afib). With this condition, the electrical signals are generated outside the sinoatrial node. Rather than traversing the atria in a uniform pattern, they spread erratically. This causes the atria to fibrillate.

If medications have proven ineffective for controlling Afib, doctors will often suggest minimally invasive maze surgery. This is a procedure during which a cardiothoracic surgeon creates a maze of scar tissue across the surface of both atria. Because scar tissue is unable to conduct an electrical current, the signals are guided along a defined path toward the atrioventricular node. Below, we’ll briefly explain how the Maze procedure is performed.

Anesthesia And Right Lung Deflation

The first step is to administer general anesthesia. A breathing tube is then inserted down the throat in order to deflate the patient’s right lung. This is a significant departure from past variants of the procedure. Early versions of maze surgery required the patient’s heart to be stopped and connected to a heart-lung bypass machine. This machine was necessary in order to maintain the circulation of blood and oxygen during the operation. The breathing tube allows the patient to breathe through one of the lungs, thereby making the heart-lung bypass machine unnecessary.

Incisions And Left Lung Deflation

Once the right lung has been deflated, the surgeon makes three (occasionally, four) incisions into the right side of the patient’s chest. A thoracoscope equipped with a small camera is inserted through one of the incisions. Other surgical instruments are inserted through the other incisions.

The thoracoscope sends video images back to a monitor. The surgeon watches these images while opening the pericardium and encircling the heart with two catheters. Once this has been accomplished, the right lung is inflated and the surgical instruments are removed.

Three or four incisions are then made into the left side of the patient’s chest. The left lung is deflated while the thoracoscope and other instruments are inserted through these incisions. As before, the surgeon cuts the pericardium open to access the heart.

Catheters And Ablation

The two catheters that were used to encircle the heart from the right side of the chest are pulled around to create a loop. This loop helps direct the surgeon’s use of the ablation device. Beginning with the left atrium from the base of the pulmonary veins, the ablation device is used to create lesions. These lesions produce scar tissue, which forms the conduction block that guides the electrical signals from the sinoatrial node to the atrioventricular node.

Once the ablation has been completed, the left lung is reinflated. The thoracoscope and surgical instruments are removed, and the incisions are closed. The patient is then moved into the intensive care unit.

Recovery Following The Procedure

Because the Maze procedure is usually performed with minimally invasive techniques, the recovery period is much shorter than would be the case with open heart surgery. The patient will typically stay in the ICU for up to eight hours before being moved to a normal recovery room for the night. In many cases, the patient can be discharged the following day to complete his or her recovery at home. It is not uncommon to return to work within two weeks, though the ablated scar tissue may require months to fully form.

If you suffer from atrial fibrillation, ask your doctor whether minimally invasive maze surgery is a viable form of treatment. Depending on your circumstances, it may represent the most effective strategy for curing Afib.

Finding the right doctor for atrial fibrillation or Maze procedure is crucial. Visit a specialist for proper diagnosis and treatment. Check out Health Facts