A. Closed Mitral Valvotomy.
The operation for Mitral stenosis (MS) is known as Closed Mitral Valvotomy (CMV). It is usually recommended for patients with only narrowing of the valve without calcification and in young patients who have a normal regular heart beat. The operation can be performed in any major hospital by a qualified surgeon. Here a finger is passed under controlled conditions and an instrument called the dilator is introduced into the valve and the valve is forcibly opened. Patients who have irregular heart beat but do not have a clot in the heart can also undergo this operation provided a Transesophageal Echocardiography (TEE) shows that there is no clot. However, they have to be treated with blood thinning drugs (anticoagulant) for one and a half month before such an operation.
B.Open Heart Surgery
If the Mitral valve is leaking or calcified or if the aortic valve is diseased or the tricuspid valve is diseased the patient will need open heart surgery. Here the heart has to be stopped and circulation of blood and oxygenation of blood will be taken over temporarily by a machine (Heart Lung Machine) so that surgeon can look inside the heart and perform a procedure to correct the problem. Open heart surgery on the Mitral valve may be Open Mitral Commissurotomy (OMC), Mitral Valve Repair or Replacement.
i) Open Mitral Commissurotomy
Open Mitral Commissurotomy (OMC) is possible if the valve is narrowed and is not calcified. In this the diseased valve is opened up directly under vision.
ii) Mitral Valve Repair
In this operation correction of Mitral stenosis (MS) and Mitral regurgitation (leaking valves) is done under vision. This operation is suitable for young patients, and those who do not have calcification. The surgeon will reconstruct the valve so that its function is returned to near normal. The advantage is that the patient retains his/her own natural valve. He/she will not require anticoagulant medicine for all his/her life. He/she will also not require expensive hospital tests. The operation also costs about ½ to 1/3 of the cost of valve replacement with an artificial valve. This operation is also best suited for young patients, women and elderly people. However, there is possibility of second operation in future.
Replacement of the Mitral valve becomes necessary when the valve is severely damaged or calcified. It may also be required in patients who are undergoing a second operation. In this, surgeon will remove the Mitral valve and replace it with an artificial valve (Prosthetic valve); a valve made from animal tissue (Bioprosthesis) or with a human valves taken from a dead person (Homograft). Sometimes, patients own pulmonary valve can be placed in place of Mitral valve (Ross II Procedure). The cost of such operation is much more than valves repair. In addition the patient will require to take anticoagulant medicines for the rest of the life. The patient will also require blood and other tests to monitor the function of the valve at regular intervals.