The cardiac surgery

THE VALVULAR SURGERY

- The different types of valvular prostheses
- The valvular surgery of the aorta
- The surgery of the mitral valve
- The surgery of the tricuspid valve

The surgery of the mitral valve

The surgical techniques to repair the mitral valve depend very much on the indication of the operation.

Indeed, two replacement indications exist for replacing or repairing the mitral valve: the mitral insufficiency (regurgitation at the level of the valve) and mitral stenosis (difficult discharge of blood from the left atrium toward the left ventricle).

a - The surgery of the mitral valve in case of a mitral insufficiency

Two surgery methods are possible: either the valve is repaired (mitral plastic surgery) either it is changed (mitral valvular replacement).

- The mitral plastic surgery

The approach of the heart is the same as in an aortic valvular replacement: the thorax is opened by cutting the sternum (median sternotomy) or by a right thoracotomy and the extra corporeal circulation is indispensable to this operation.

The surgeon meticulously inspects the damages of the mitral valve. According to the nature of the mitral valve deterioration, the surgeon stitches this valve or repairs the valve cordages.

A ring is very often implanted around the valve so that the valve leaflets are really impenetrable.

Sometimes, when the valve is perforated, the surgeon makes a patch (a small membrane) with the help of a part of the pericardium (the tissue surrounding the heart) that he takes on the patient during surgery.

- The mitral valvular replacement

The operation requires the opening of the thorax, with the help of a section of the sternum (median sternotomy) permitting to access the heart directly.

This gesture requires an extra corporeal circulation (see the corresponding chapter).

The mitral valves are excised and the mitral valve ring (the basis on which the valves fit) is then cleaned and decalcified if necessary.

The size of the mitral ring is then measured in order to choose the size of the prosthesis.
The valvular prosthesis is fixed with the help of stitches fixed on to the ring of the mitral valve and the sides of the prosthesis.

b - The surgery of the mitral valve in case of a mitral stenosis

Various surgical techniques sometimes permit avoiding the implantation of a valvular prosthesis within a mitral stenosis.

- The percutaneous mitral valvuloplasty

This technique consists in inserting a small balloon at the level of the mitral valve, then in inflating it so that the valve opens up. This small balloon is inserted at the level of the valve after having been introduced through a vein (generally the one of the groin, the femoral vein) and having passed through the membrane situated between the two atria (interatrial septum).

The risks of this operation are represented by the embolic accidents, the cardiac perforation and the occurrence of a mitral regurgitation then requiring an emergency replacement of the mitral valve.

- The mitral commissurotomy

This surgical technique consists in separating the mitral valve leaflets, with the help of a merely mechanical means (valve “dilator”).

- The mitral valvular replacement

It is necessary when the valves are too much damaged or if a complementary mitral insufficiency exists.

The technique is the same as the one described in the chapter concerning the mitral insufficiency.

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File last modified on june 21, 2006