Mitral Valve Repair & Replacement

Outlook

Before the procedure

It’s 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 who have an allergy to the intravenous (IV) dye must tell the doctor or nurse so that medication to prevent a reaction can be prescribed. People who 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 two days in advance for intravenous blood-thinner therapy with heparin.

During the procedure

A mitral valvuloplasty 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. The process of the procedure is as follows:

1. A special echocardiogram (echo) known as a transesophageal echocardiogram (TEE) will be performed the morning of, or in the weeks prior to, the procedure. The patient is put to sleep with medication and a small ultrasound probe is passed down the swallowing tube (esophagus). The heart structures are then viewed through the wall of the esophagus. This isn’t a painful procedure because the individual is asleep during the test. It’s a very important test because it detects any blood clots that are in the heart. If a blood clot is found, the valvuloplasty usually won’t be performed because the risk of causing a stroke would be too high.
2. The valvuloplasty procedure is done in the cardiac catheterization lab using X-ray and a dye that is injected into the bloodstream. Local anesthetic (numbing medicine) is given in the crease of both legs before the tubes are placed into the blood vessels in that area.
3. 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 sleep during the procedure. Patients aren’t put into a deep sleep, however, so that they can talk to the doctor during the procedure.
4. A soft, plastic tube (catheter) is passed through the bloodstream up to the heart where pressure measurements are taken and the arteries of the heart are visualized. This doesn’t cause pain because there are no nerves inside those blood vessels.
5. 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.
6. 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 five to 10 seconds.
7. When the procedure is finished, all of the tubes and the balloon are removed from the bloodstream, 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.