Download Mitral Valve Stenosis

Mitral Valve Stenosis
Mitral stenosis is a narrowing of the mitral valve. The mitral valve is one of four valves that
regulate blood flow through the heart. It lies between the left upper and left lower cardiac
chambers.
When the mitral valve is narrowed, blood flow to the left lower chamber of the heart is limited.
The blood is trapped in the left upper chamber, putting pressure on the blood vessels that bring
blood from the lungs to the heart. Over time, this may cause the upper left and right chambers of
the heart to enlarge.
Patients with narrowing of the mitral valve can experience fatigue and shortness of breath,
especially when climbing stairs, exercising or doing other activities.
If your valve becomes severely narrowed, you may need to have it repaired or replaced. Without
treatment, mitral stenosis can lead to serious heart complications.
Treatments
Depending on your condition and symptoms, your doctor may recommend the following:
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Medications and salt restricted diet
Surgical treatments
Mitral valvuloplasty
Medications
If tests show minor or moderate narrowing of the mitral valve, your cardiologist may recommend
monitoring your condition during regular checkups. Some people never require replacement or
repair of their valve because they never develop severe mitral stenosis.
If you experience symptoms, your doctor may prescribe medications to provide relief. These
medications may include the following:
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Diuretics: Drugs that help reduce fluid accumulation in your body by increasing fluid loss
through urination.
Blood thinners, or anticoagulants: Drugs that help prevent blood clots from forming;
Antiarrhythmics: Drugs to control an irregular heartbeat, such as the too-fast heart
rhythm of atrial fibrillation (AF).
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Antibiotics: The American Heart Association no longer recommends that people with
narrowed heart valves take antibiotics prior to routine dental cleaning.
Salt (Sodium) Restriction: Foods high in salt (sodium) can cause fluid retention and
worsen symptoms related to heart valve disease. A low salt diet of only 2-3 grams of
sodium per day is recommended, which means that salt should not be added to food, and
high sodium foods like deli meats, nuts, canned soup, and fast food should be avoided.
Even if you are on medications, you may notice an increase in fatigue or shortness of breath. If
this occurs, you should let your doctor know immediately.
Surgical Treatments for Mitral Stenosis
Your cardiologist may recommend surgery to repair or replace a narrowed mitral valve.
What to expect
Before surgery, you will receive a general anesthetic, which is a medicine that puts you into a
deep sleep during the procedure. Your doctor will make an incision (cut) along the length of your
breastbone (the flat bone in the center of your chest) to expose your heart. You will be connected
to a heart-lung machine, which will take over your breathing and blood circulation during the
surgery. The surgeon will stop your heart, make a cut in it to expose the valve, then repair or
replace the valve.
Valve repair
Surgery to repair the mitral valve may be an option in rare cases of mitral stenosis. Improved
blood flow through the valve can be accomplished by surgically separating the valve’s leaflets,
removing tissues that obstruct the valve or making adjustments to the fibers, or cords, which hold
the base of the valve’s flaps to the heart.
A valve repair may not last or be successful and may need to be repeated.
Valve replacement
If your valve cannot be repaired and it must be replaced, your surgeon will implant an artificial,
or prosthetic, valve. An artificial valve can be made of metallic or tissue components.
Mechanical valves
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Mechanical valves are devices made of metallic materials, such as titanium. They offer life-long
durability. The main risk with mechanical valves is blood clot formation (thromboembolism). In
order to prevent blood clots after receiving a mechanical valve, you will need to take blood
thinning medications for the rest of your life.
A secondary risk is associated with taking the blood-thinning medications. Blood-thinning
medications increase the risk of bleeding. If the drugs make the blood too “thin,” you can
experience excessive bleeding, even with minor cuts. If the blood is too “thick,” clots can form
on the valve. A clot could later break off and lodge in the blood vessels to the heart or brain,
blocking blood flow and leading to heart attack or stroke.
Careful monitoring to ensure the correct levels of anticoagulation medications is critical. It may
require a monthly visit to the doctor’s office. New home monitoring units may make it possible
to regulate your blood levels without going to the doctor’s office.
Tissue valves
Tissue valves are made of valve tissue taken from a cow (bovine), pig (porcine) or human
(homograft) cadaver. Because they do not encourage blood clot formation, patients who receive
tissue valves do not need to take blood-thinning medicines.
However, tissue valves have not historically been as long lasting as mechanical valves. A tissue
valve (also called a bioprosthetic) can wear out over a period of 10 to 15 or more years. If it
deteriorates significantly, it must be replaced. Replacement, of course, requires repeat surgery.
Because of durability concerns, tissue valves are implanted primarily in older patients. However,
tissues valves have improved steadily and are being used more and more frequently.
Risks of surgical treatment
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Death. The overall mortality risk (risk of death) for heart valve surgery is less than 5
percent (5 out of every 100 patients).
Irregular heartbeat or arrhythmia. Arrhythmias can make you tired or short of breath and
put you at risk of blood clots. You may need to take blood-thinning medications to lower
the risk of blood clots, which may form in the heart due to irregular heartbeat.
Infection. After valve surgery, you may be prone to endocarditis, an infection or
inflammation of the heart valves. It occurs when bacteria enter the bloodstream and infect
damaged valve leaflets. People who have abnormal or damaged heart valves or who have
received an artificial heart valve are more vulnerable to the infection.
Risks associated with being put to sleep with general anesthesia.
Risks, such as bleeding, associated with surgery.
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After mitral valve surgery
Your recovery in the hospital may last from four to 10 days, depending on your condition. You
may spend the first days after surgery in an intensive care unit (ICU) where your heart will be
closely monitored.
While in the ICU, you may have a number of tubes in your body to help recovery, including a
tube to help you breathe, a tube to drain fluids from the stomach while you are not eating, tubes
to drain fluid from your chest, a small tube to empty your bladder and a tube into your arm to
measure blood pressure. These will be removed when you are moved out of the ICU to another
care unit.
You will receive therapy to prevent complications such as pneumonia, collapsed lung or
infection. A nurse or therapist may lead you in deep breathing exercises and coughing and
encourage you to move your legs to lower the chance of blood clot formation. Your therapy may
also include gentle patting on the back to loosen fluids in the lungs.
Physical therapy will also be part of the recovery process. In the hospital, you will be encouraged
to walk around and you will be shown how to move your arms without hurting your breastbone.
Pain medication will be given to ease the discomfort of the surgical incision and you will also
learn how to do daily activities in ways that will not interfere with the healing process.
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Mitral Valvuloplasty
(Content provided courtesy of Evanston Hospital, Evanston, Illinois.)
Description:
This is a non-surgical procedure that may be used to open a narrow valve within the heart.
Mitral stenosis:
A narrowing (or stenosis) of one of the four valves within the heart. Valves normally open and
close with each heart beat to allow blood to continue in a forward motion through the heart.
When a valve is narrow, it does not open as much as it should, so the pressure of the blood backs
up within the heart and causes the blood vessels in the lungs to have too much pressure. Think of
a garden hose that is kinked and resulting pressure that builds up at the wall faucet. This can
cause a person to be short of breath, especially with exertion such as climbing stairs or
exercising.
What to expect:
The procedure can be performed on the same day of admission to the hospital and although some
patients may be discharged at the end of the day, people usually stay the night in the hospital.
People that take the blood thinner Coumadin, must be switched to the short acting blood thinner
Lovenox (which is injected like insulin) or admitted to the hospital 2 days in advance for
intravenous blood thinner therapy with Heparin.
A special echocardiogram (ultrasound of the heart) will be performed the morning of, or in the
weeks prior to the procedure. This is called a trans esophageal echo in which the person is put to
sleep with IV medication and a small ultrasound probe is passed down the esophagus (the
swallowing tube). The heart structures are then viewed through the wall of the esophagus. This is
not a painful procedure because the individual is asleep during the test. It is a very important test
because it detects any blood clots that are in the heart. If a blood clot is found, the valvuloplasty
usually will not be performed because the risk of causing a stroke would be too high.
The valvuloplasty procedure is done in the cardiac catheterization lab using X-ray and a dye that
is injected into the blood stream. Local anesthetic (numbing medicine) is given in the crease of
both legs before the tubes (or sheaths) are placed into the blood vessels in that area. Once the
numbing medicine has taken effect, there should only be a sensation of pressure while the tubes
are placed. Intravenous medicine for relaxation is usually given, so that a person may doze off to
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sleep during the procedure. People are not put into a deep sleep, however, so that they can talk
to the doctor during the procedure.
A soft plastic tube is passed through the blood stream up to the heart where pressure
measurements are taken, and the arteries of the heart are visualized using X-ray and intravenous
dye. This does not cause pain because there are no nerves inside those blood vessels. Once the
measurements are taken, a tiny needle is used within the heart to cross from the right side into
the left side. The two sides of the heart are separated by a muscular wall, which is crossed with
the tiny needle. The valvuloplasty balloon is passed through the wall and positioned across the
narrow mitral valve. The balloon is quickly inflated and deflated within the valve to stretch the
valve open. This may be performed two or three times. During balloon inflation, a person may
feel warmth or flushing in the face or chest, pressure in the chest, or mild chest discomfort. This
usually passes in 5 to 10 seconds. When the procedure is finished all tubes and the balloon are
removed from the blood stream and pressure is applied to the site in the crease of the leg to
prevent bleeding. Bed rest for a few hours after the procedure is important to prevent bleeding.
Risks associated with the procedure:
The doctor and nurse discuss risks in detail with all patients. Those risks include:
 There is a small risk of bleeding from the site where the tubes enter the skin. The sites
may be closed with a “stitch” or a “glue plug” or may be held by manual pressure after
tubes are removed. Bed-rest is necessary for a few hours after the procedure to reduce the
chance of bleeding. In a rare situation a blood transfusion or surgery to repair a damaged
blood vessel in the leg may be necessary.
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There is a small risk of a stroke, heart attack, allergy or kidney problems related to the IV
dye, irregular heart rhythm and rarely death.
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There is a small chance that the balloon will not improve the opening of the valve. In that
case the doctor may discuss scheduling open-heart surgery to replace the valve in the
following weeks or months.
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There is a small chance that the balloon may damage the valve, which would require
open-heart surgery to replace the valve, possibly even that same day; this chance is
approximately 3 people in 100.
What to do before the procedure:
It is important not to eat or drink anything after midnight the night before the procedure.
Medications are usually taken with sips of water during that time, but specific instructions are
given to each person beforehand. Those individuals that have an allergy to the IV dye must tell
the doctor or nurse so that medication to prevent a reaction can be prescribed. Persons taking
blood thinners will be instructed when to stop prior to the procedure. Glasses, dentures and
hearing aids are permitted during the procedure.
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