Patients affected by Mitral Valve Stenosis typically develop symptoms (Symptomatic). These typically develop during exertion or conditions which stress the body. Sometimes symptoms will go un-noticed by patients justifying them as part of getting older or some other disease.
Some of the symptoms can be confused for pneumonia or a upper respiratory illness. Mitral Valve Stenosis can produced any of the following symptoms alone or in combination:
Watch this short video from the American Heart Association comparing a normal Mitral Valve to a stenotic one.
Mitral valve stenosis can arise following an infection with a bacteria called streptococcus. This bacteria is associated to strep throat and scarlet fever. If either of these infections are untreated they can lead to a serious condition called rheumatic fever which is an inflammatory/immune condition which affects the heart and joints.
Now a days rheumatic fever not as common as it used to be thanks to tests that lead to the early recognition of the bacteria and the prompt use of antibiotics. However, rheumatic fever is still prominent in underdeveloped countries.
Other causes of Mitral Valve stenosis include cancers, radiation to the chest (radiation heart disease), and conditions which cause calcium to lay onto valves.
Ever wonder what Mitral Valve stenosis looks like? Watch this short video to get an idea.
Notice how stiff the anterior and posterior leaflets are. Additionally, look at the small opening caused by the thickened leaflets. Finally, notice how part of the disease process is leaflet fusion which the surgeon points to in the video.
When the Mitral Valve can not open effectively it is said to be stenosed. In other words, the valve closes off as a result of a disease, or because a person was born with a Mitral Valve which does not completely open. The difference between these two examples are what separates people with acquired valve disease (ie having an infection that affects the valve) and congenital valve disease (ie born with an abnormal valve).
In either case, the event causes the valve to swell resulting scaring as part of the healing process. The scarring is what causes the valve to stiffen and ultimately close off.
Mitral Valve Stenosis produces turbulence as blood passes through the valve. Turbulence is what results in a murmur which typically is heard during the phase of the cardiac cycle called diastole (REMEMBER! WE DEFINED IT EARLIER IN THE POST ABOUT MITRAL VALVE FUNCTION!)
Watch in this short (30 second) video how the Mitral Valve fails to completely open when compared to the valve at its side. Also pay close attention to the sound of the murmur during diastole.
So you are going to have open heart surgery, what’s next?
How to prepare the day before surgery: Always get a restful night’s sleep and eat a healthy meal. You should not eat or drink anything except small sips of water with your medications after midnight on the day before surgery.
What to expect during your hospital stay: The day of surgery you will meet your anesthesiologist and your operating room nurse. They will take great care of you and ensure your comfort until it’s time to go to sleep. Patients are placed under full anesthesia which includes a breathing tube. Most surgeries range between 4-6 hours in duration. After the surgery, you will wake up in the intensive care unit. There you will meet your ICU nurse and the team of doctors, physician assistants, nurse practitioners, dieticians, and therapists who will be taking care of you. Once you’re fully awake, we can remove the breathing tube and you can start to drink sips of water and ice chips. We encourage early mobilization from day 1 so you can expect to be up in a chair and walking within the first 24 hours of surgery. Because the breastbone is divided in surgery, it’s normal to have pain in the middle of your chest, along your back and in your sides. We also place drains in surgery which will be removed 1-2 days later. Removal of the drains helps allow for deeper breaths and can alleviate some of the pain. Coughing and sneezing tend to exacerbate the pain so we give you a heart shaped pillow to hug while coughing or sneezing to help ease the discomfort. That heart pillow and your incentive spirometer will be your best friends for the next month! Most patients spend 1-2 nights in ICU and then move to the telemetry floor. Here you will continue to walk around in the hallways and do breathing exercises to get your lungs back in good shape. We cannot stress how important it is to walk and sit in the chair for all of your meals early on, not only does it prevent respiratory complications it also helps relieve some pain. Your providers will be making medication adjustments, monitoring your vitals and preparing for your discharge. Most people go home on discharge with a family member or friend to help. Occasionally, if you’re still too weak to walk independently or you have other therapy needs we can make the necessary arrangements for you to go to more intensive rehab. The average hospital length of stay is about 4-7 days.
Yay, I’m going home, now what: When you’re released to go home we expect you to continue to walk at least 3 times a day, sitting up in chair – not lying in bed all day! Walking at least 30 minutes of day is a good rule of thumb. Initially, patients feel weak and tired but as you mobilize and participate in rehab you'll feel your strength return gradually. We want you to get back to your normal routine in about 4-6 weeks. Activity restrictions include no lifting/pushing/pulling greater than 5-10 lbs. and no driving for 4 weeks from surgery. We will see you in our clinic 1 week and 1 month after discharge. Call us at 214-820-7100 or visit our clinic if you have any questions about your recovery. If you develop fevers, incisional redness or drainage, or significant swelling in your legs and weight gain call the clinic so we can address these issues. And remember, if something doesn’t feel right and you cannot wait call 9-1-1 for emergencies.
1. I’m having pain what should I do?
a. Ask the staff prior to trying Tylenol and Ibuprofen if not on any other prescription pain pills
i. Alternating them is helpful so taking 325mg every 4 hours and then taking ibuprofen 200mg every 6 hours.
ii.Heating pads are also very helpful for local pain control
2. What medications can I expect to be on after heart surgery?
a.Most cardiac surgery patients are on 4 medications: aspirin, cholesterol lowering medication (“statin”), heart lowering medication (“beta blocker”) and a blood pressure lowering medication
3. How do I take care of my skin incisions?
a.Some drainage from the incision is ok
i.Monitor temperate with a thermometer
ii.If you are changing the bandage or dressing on your wound site 2-4 times every hour then it is a problem! Call 214-820-7100
b.Plain bar soap and water is great for the incision
i.Avoid fancy shower gels and loofahs
c.Leave the incisions open to air
i.Moisture can be a nidus for infection!
d.Avoid scar removing agents and lotions where the incision is still healing
4. When will my post-operative visit be and what should I expect?
a.Bring a daily log of your temperature, weight, blood pressure, and heart rate
b.Usually record your blood pressure and heart rate two times a day
c.Bring all of the medications you are taking to the office (or take a picture of all the bottles and bring them to the office)
d.Come 30 minutes earlier than the appointment time to have time to get the chest xray
e.Office visits are 1 week, 1 month and 3 months after discharge from the hospital.
5. When will cardiac rehab start?
a.Explore locations near your home!
b.You will usually start cardiac rehab after the first office visit.
c.Cardiac rehab is important to ensure a safe transition for strength and conditioning after surgery.
6. What other follow up appointments should I make?
a.Make sure to make an appointment with your Primary Care Doctor within 2 weeks to 1 month from discharge to discuss medication changes and updates.
i.Give the Primary Care Doctor our fax number 214-820-6863 so we can fax hospital reports to their office
b.Make sure to make an appointment with your Cardiologist within 4-6 from discharge to discuss medication changes and updates.
a.Call us at any time 214-820-7100. We are at your service and can help you with your questions!
This post was written by:
Anju Garg, MPAS, PA-C
Senior Cardiac Surgery PA
Baylor Scott & White Health
A Heart Transplant Selection Committee is a group of healthcare providers responsible for the evaluation and listing of patients suffering of end-stage heart disease. This group is composed of surgeons, cardiologists, social workers, immunologists, heart transplant coordinators, pharmacists, nutritionists, and heart transplant administrators. The group typically meets on a weekly basis to discuss patients seeking transplantation.
The process of evaluation is very stringent requiring each patient to submit him- or herself to a battery of tests aimed at determining candidacy. Information produced by testing will help to determine medical need, surgical and psychosocial risk. Medically most patients suffer of heart failure which cannot be controlled with medicines. This is largely determined by the heart failure cardiologist. From a surgeon's point of view, we determine surgical suitability based on a number of surgical variables. Some related to the risk of operating on the patient and the chances of whether the patient will tolerate the surgery. Surgeons also provide insight as to the impact of risk factors in the long term effect of pre-existing conditions affecting success. Social Services help determine if the patient has the social and financial resources to have a successful long term result.
Watch this 360 video to get a glimpse of how a Heart Transplant Selection Committee works.
Take a close look inside the heart and watch how the Mitral Valve works. Also watch what the different conditions look like when compared to a normal Mitral Valve. watchlearnlive.heart.org/CVML_Player.php?moduleSelect=prolap
IT"S SUPER BOWL SUNDAY!!!!!! Time for sitting on the couch and watching your favorite (and maybe not so favorite) team compete for the ultimate football prize!
And as many good Hearted Americans we will make sure that there is plenty of food and drinks to enjoy this classic day! I did take a few minutes to scan the internet to find a set of healthy options to serve at your Super Bowl party!!!!
These recipes I found on Health.com may do the trick!
The Mitral Valve works to maintain forward flow of blood through the heart. It functions by opening during the phase of the cardiac cycle called diastole. Diastole happens when, in the case of the left side, the left ventricle relaxes and receives oxygenated blood from the left atrium. Once the left ventricle is full the Mitral Valve closes to allow the oxygenated blood to be pushed out to the body by the contracting left ventricle. This phase of the cardiac cycle when blood is pushed, or ejected, out of the heart is called systole. If the mitral valve where unable to close properly then blood would leak back, or regurgitate, into the left atrium. In this case the Mitral Valve is said to be incompetent, a term used to described the condition of Mitral Valve Insufficiency. In medicine Mitral Valve Insufficiency and Mitral Valve Regurgitation are synonymous with each other. Watch the short video (33 seconds) below to see how the Mitral Valve functions normally and what happens when insufficiency occurs.