Our Summary

This study is about an 86-year-old woman who had a severe issue with her aortic valve (a heart valve that controls blood flow from the heart). To treat this, a procedure called transcatheter aortic valve replacement was performed. In this process, a balloon-expandable valve was placed in her heart using a stiff guide wire that was able to straighten the aorta (the main artery that carries blood away from the heart).

However, during the procedure, the balloon moved out of place. After the artificial valve was put in, another procedure called intraoperative transesophageal echocardiography (a type of ultrasound test that provides detailed pictures of the heart) found that the patient had severe mitral regurgitation (a condition where the heart’s mitral valve doesn’t close tightly, allowing blood to flow backward in the heart) from the front leaflet of the mitral valve (a valve in the heart that controls blood flow between the upper and lower chambers of the heart on the left side).

The doctors had to immediately perform open-heart surgery. They found a 5-mm hole in the front leaflet of the mitral valve and decided to directly close it to repair the valve. The study notes that while this method of replacing the aortic valve has become popular for patients with severe aortic stenosis (a narrowing of the aortic valve opening) and high surgical risk, instances of mitral valve perforation (a hole in the mitral valve) are rare.

FAQs

  1. What complications occurred during the transcatheter aortic valve replacement procedure in the case study?
  2. How was the severe mitral regurgitation issue identified and resolved?
  3. How common are mitral valve perforations during transcatheter aortic valve replacement procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve replacement is to follow all post-operative instructions carefully, including taking any prescribed medications, attending follow-up appointments, and participating in cardiac rehabilitation if recommended. It is important to monitor for any signs of infection, such as fever or increased pain, and to contact your doctor immediately if you experience any concerning symptoms. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help promote optimal healing and long-term success of the mitral valve replacement.

Suitable For

Patients who are typically recommended for mitral valve replacement include those with severe mitral regurgitation, mitral stenosis, or a combination of both. These patients may have symptoms such as shortness of breath, fatigue, palpitations, or swelling in the legs. They may also have evidence of heart failure, such as fluid retention or an enlarged heart on imaging studies. Patients with severe mitral valve disease who have failed medical management or are at high risk for complications from surgery may be considered for mitral valve replacement. Additionally, patients with other cardiac conditions, such as aortic valve disease or coronary artery disease, may also undergo mitral valve replacement as part of a larger surgical procedure.

Timeline

Before Mitral Valve Replacement:

  • Patient presents with symptoms of severe mitral valve disease, such as shortness of breath, fatigue, and chest pain
  • Diagnostic tests, such as echocardiogram and cardiac catheterization, are performed to confirm the severity of the mitral valve disease
  • Treatment options are discussed, including mitral valve repair or replacement
  • Decision is made to proceed with mitral valve replacement surgery

After Mitral Valve Replacement:

  • Patient undergoes preoperative preparation, including blood tests, imaging studies, and consultation with the surgical team
  • Mitral valve replacement surgery is performed, either through traditional open-heart surgery or minimally invasive techniques
  • Postoperative recovery period in the hospital, which may include monitoring in the intensive care unit
  • Rehabilitation and physical therapy to regain strength and function
  • Long-term follow-up with the cardiac team to monitor the function of the prosthetic valve and overall heart health.

What to Ask Your Doctor

  1. What is the reason for needing a mitral valve replacement?
  2. What are the different types of mitral valve replacement options available?
  3. What are the risks and benefits of each type of mitral valve replacement?
  4. How long is the recovery process after a mitral valve replacement surgery?
  5. What are the potential complications or side effects of mitral valve replacement surgery?
  6. Will I need to take medication after the surgery, and if so, for how long?
  7. Will I need any follow-up appointments or tests after the surgery?
  8. How long can I expect the new mitral valve to last?
  9. Are there any lifestyle changes I should make after the surgery to help with my recovery and overall heart health?
  10. Are there any restrictions on physical activity or diet that I should be aware of after the surgery?

Reference

Authors: Higa S, Nagano T, Yamashiro S, Iwabuchi M. Journal: Asian Cardiovasc Thorac Ann. 2020 Jun;28(5):276-278. doi: 10.1177/0218492320930842. Epub 2020 Jun 1. PMID: 32479110