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INTRODUCTION
The aim of this booklet is to provide you with information about
mitral valvuloplasty so that you are better prepared for the
procedure.
www.yourheart.org.uk is one of the first interactive web sites
for heart patients and their relatives and friends in the UK. This
site will offer heart and health related information available.
TRANSLATION
If you would like this information in another language or format,
please contact the Service Equality Manager on 0116 258
4382.
WHAT IS MITRAL STENOSIS?
Mitral stenosis is a heart condition where the mitral valve on
the left side of the heart narrows and thickens causing
obstruction of blood flow through the heart.
WHAT IS MITRAL VALVULOPLASTY?
Mitral Valvuloplasty involves stretching the mitral valve with a
balloon, which is threaded into the heart through the vein
(femoral) in the groin.
Haddaad rabto warqadan oo turjuman oo ku duuban cajalad
ama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta
0116 258 4382.
Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını
isterseniz lütfen servis müdürüne 0116 258 4382 telefonundan
ulaşabilirsiniz.
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HOW DO I NEED TO PREPARE MYSELF?
If you are taking Warfarin this
needs to be stopped for 3 days
before your procedure. You should
shower or bath on the morning of
the procedure.
You will be
informed when to stop eating and
drinking; this is usually 4 hours
prior to the procedure taking place.
It is important that you shave your hair to both sides of your
groin areas, as this is where the tube is passed into the
femoral vein at the top of your leg. If you are concerned about
doing this, the nurse will be able to help you.
THE PROCEDURE
Mitral Valvuloplasty is sometimes performed under local
anaesthetic, at other times under general anaesthetic. If a
general anaesthetic is used this allows a transoesophageal
probe to be passed into the gullet so that the mitral valve can
be assessed during the procedure. If local anaesthetic is used,
assessment of the mitral valve is made by an echo test from
the chest wall.
When you arrive in the catheter
room you will notice that there is a
lot of machinery. Although this can
be quite overwhelming, don’t be
alarmed.
This
is
specialist
monitoring and x-ray equipment and
will not harm you in any way.
The valvuloplasty catheter is relatively large and bleeding into
the puncture site from the groin where the catheter is
introduced may occur. Sometimes in about 5% of patients
there may be significant bruising and damage to the groin
vessels and a surgeon may need to repair these.
Withdrawal of the balloon used to dilate the valve across the
atrial septum may sometimes lead to a large as opposed to a
very small hole present in the atrial septum. A hole in the heart
(atrial septal defect) may then be produced and in rare
occasions may need later surgical closure.
The procedure involves using x-ray
equipment therefore the amount of radiation
you are exposed to is monitored carefully
especially as the procedure can last several
hours. The radiation risk and the x-rays used
is equivalent to 4.2 years background
radiation (radiation that is normally found in
the atmosphere which is present in everyday life).
If you have any specific worries about any of these issues,
please discuss them with your consultant.
You will be required to lie on a hard
x-ray table and heart monitor wires
will be attached to your arms and legs.
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If you develop any problems at home or need some medical
advice, do not hesitate to contact the ward. You may be able
to speak to one of the doctors or nurses who looked after you.
A follow-up appointment is not always necessary. If we do need
to see you again in outpatients you will be informed by letter.
IS THERE ANY RISK?
To begin the procedure, the doctor will clean your left and right
groin areas with a cold antiseptic liquid. He will then cover you
with green cloths to maintain a sterile working area. You will
then be injected with local anaesthetic in both groins to freeze
the area where the tubes will be inserted into the blood vessels
(one in either side).
Through the tubes, the doctor will pass catheters up into the
heart to measure the pressures in the heart.
Any operation carries a risk to life and to limb
and the mortality risk in Mitral Valvuloplasty is
0.5% i.e. 1 in 200 patients.
The main risk of stretching a mitral valve is for
the valve to become severely leaky. A mild increase in the
amount of leak (regurgitation) is quite common with the
procedure. However, in about 5% of patients the valve
becomes significantly leaky and will require replacement within
6 months. In about 2% of patients this is necessary as an
emergency during the valvuloplasty procedure.
It is necessary to puncture the wall between the two receiving
chambers (the atrial septum between the right atrium and the
left atrium to gain access to the mitral valve). There is a risk that
sometimes a needle puncture may not end up in the correct
place and the wall of the heart be punctured
and bleeding occurs into the heart sack.
This might require emergency surgery. The
total risk of emergency surgery is
approximately 2% (1 in 50 patients).
Most patients with Mitral Stenosis have an irregular heart
rhythm known as atrial fibrillation however, some patients still
are in normal rhythm (sinus rhythm) and this procedure may
lead to atrial fibrillation. This is not usually serious.
During the procedure you may have injections of x-ray dye into
the heart which will make you experience hot flushes.
These will last for only a few seconds and are not painful.
Shortly, following these, one of the tubes in your groin will be
exchanged for a slightly bigger tube. Some more local
anaesthetic may be injected into the site to reduce any
discomfort. The bigger tube is a special catheter, which is
passed up into the heart and serves to make a small opening
from one side of the heart to the other. At this point you will be
given an anti-clotting drug through the
needle in your hand/arm. The way is now
clear for a balloon mounted on a catheter to
be passed up into the heart valve where it is
blown up and let down again. This may be
repeated a few times. At this point you may
feel dizzy; this is quite normal.
Once the balloon has been let down and
pulled out, you may have another x-ray dye
injection.
The procedure takes 2-3 hours and you will have a nurse to
support and reassure you for this duration.
As with open heart valve surgery there is a small risk of 1-2%
of stroke.
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You will have a tube in each groin called a sheath, whilst in
place you need to stay on bed rest. It is also important to keep
your leg straight so that bruising is kept to a minimum. They
will be removed either in the ward or in the catheter room suite.
ON RETURN TO THE WARD
Your nurse will collect you from the catheter suite where a brief
handover is given about you.
You will now be advised to stay on
bedrest for 2-4 hours. It is important
to check your ‘sheath site’ on a regular
basis in case any bleeding or oozing
develops. If any bleeding occurs let
the nurse know. The plaster can stay in place for two days
then it can be removed, as exposure to the air enables the
wound to heal.
BEFORE DISCHARGE
On return to the ward, the nurse will
check your blood pressure, pulse
and pulses in your feet (called
‘pedal pulses’).
An ECG 4
(Electrocardiograph
or
heart
tracing) will also be performed.
These are all routine checks that
are
required
in
case
any
complications develop.
You will also be connected to a drip - or IVI (intravenous
infusion), that will be running for approximately 4-6 hours.
On the evening of the procedure your usual dose of Warfarin
should be restarted.
Sometimes a repeat echocardiogram will be requested. An
echocardiogram is a scan of your heart using ultrasound
equipment. This will occur the following day.
DISCHARGE
If there are no complications you will be able to go home the
day after your procedure. The doctors will speak to you about
your results.
SHEATH REMOVAL
After approximately 2 hours if your sheaths are still in, a
sample of blood will be taken to see if your blood clotting time
is back to normal. Then your sheath can be removed. When
the sheaths are being removed, a nurse or
doctor will press quite hard for at least 1020 minutes. You will be connected to a
cardiac monitor so that the staff can ‘keep
an eye’ on your heart rate.
Once the sheaths are removed, you will have to place your
hand on your sheath site - using a piece of gauze for at least
20 minutes. If you need to cough, laugh, sneeze etc., please
make sure you press on the gauze.
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You should do as little as possible for two days this
means,
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NO HEAVY LIFTING
NO CLEANING
NO SHOPPING
NO GARDENING
You are advised not to drive for two days. You do NOT need
to contact the DVLA unless you hold a PSV/HGV licence
It is common to experience some bruising to your groin area however, if a painful large lump appears, seek medical advice.
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This booklet has been written by:
Nikki Gardiner, RGN, Ward 32
and
Giselle Broomes-Pakeerah, RGN
with helpful advice from:
Dr. Peter Hubner, Consultant Cardiologist.
CARDIAC SERVICES
Booklet design by:
Kay Pratt
Cardiac Services Secretary
MITRAL VALVULOPLASTY
All Rights Reserved
NG/GB-P/SHM/KAP
March 1998
Updated April 2007
University Hospitals of Leicester NHS Trust
Glenfield Hospital
Groby Road
Leicester
LE3 9QP
A PATIENT GUIDE
University Hospitals of Leicester
NHS Trust
Telephone: 0300 303 1573
Fax: 0116 2583950
Minicom: 0116 2879852
Glenfield Hospital