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.
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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.
 
 
 
                                                                  FAQs

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.

7.  Questions?
 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
Dallas, Texas

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!
http://www.health.com/health/gallery/0,,20338949,00.html

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.

​​The mitral valve is one of four valves in the heart.

​​The mitral valve is located on the left side of the heart between the left atrium and left ventricle. 

​This valve, like many other valves, functions to allow movement of blood in one direction between the aforementioned chambers. 

​Structurally, the mitral valve is made up of 2 leaflets. Based of the leaflet’s anatomical location we call one the anterior mitral valve leaflet, and the other is called the posterior mitral valve leaflet. 

Each leaflet structurally resembles a parachute.  The leaflets are anchored to the heart by 2 ways.  The first is the hinge point, which attaches the mitral valve annulus. The annulus is the frame that divides the left atrium from the left ventricle.  This is similar to the hinge point of a door, allowing the valve to open and close.  The second point of attachment is to the chordae tendineae and papillary muscles.
​

Each of these structures prevents the valve from flapping or billowing when opening and closing, and contributes to the stability of valve and cardiac function.  The entire structure is known as the mitral valve apparatus. 
​

Have you ever wondered what a donor heart sees before it's transplanted?  Well, that was one of the reasons we created WAITING.
WAITING, with the help of broadcast company G9MD, depicts the trajectory of a donor heart as it sits waiting at different times during the transplant process​.
The title of the project was aimed at describing the different moving part that have to wait for the transplant to take place.  For instance, the donor heart WAITS to be placed.  The recipient is placed on a WAITING list.  Finally once the donor and recipient are matched the anxious WAIT begins for the transplant team as the heart is removed, transported and delivered to the operating room.  It culminates with the transplant team quickly sewing the donor into the recipient. However, no one really gets to celebrate until after WAITING for the first heart beat!!!!!
Watch the video to get a good perspective of the emotion!!!!!

​A few years ago our heart transplant program decided to establish an activity called Celebration of Life.  The intent of this event was to celebrate the work done by all in the heart transplant program during a particular calendar year.
During the event, we highlight and celebrate many aspects of the program. From the volumes to the outcomes, to the recipients who trusted us to care for them the Celebration of life has become a revolving yearly event.
Because we believe the success of our program is due to the work of many we take the time to give out a number of awards.  Individual awards are distributed depending on the particular team the person works in (i.e. Clinic Staff, operating room, ICU, etc..) and the winners are selected by their peers.  Additionally, we give out the Dr. John Capehart Award, which is was created to immortalize the passionate work of Dr. Capehart in the heart transplant program, and is given to an individual who during the calendar year went above and beyond in caring for our patients.  Previous two recipients have been Dr. Shelley Hall from Heart Failure Cardiology and Ms. Ashley Cross from the Heart Transplant Clinic.
The evening ends with an emotional closure by recognizing the recipients in our program. During this part of the event each patients receives a certificate commemorating another year of life!
While in the past few years the Celebration of Life was organized by a handful of individuals this year a committee made up of several representatives within the program have created the agenda.  I've the seen the final program and I have to say they did a spectacular job!!!!!!
So, get ready to celebrate life once a gain and make sure you attend!!! This year the Celebration of Life will take place on February 2nd 2017 in the 10th Floor of the Sammons Cancer Center.  

For more information call or email at the above.

By now you have been told you have blockages in your coronary arteries and you need to meet a heart surgeon.  I completely understand the overwhelming feeling.  What is going to happen? What are the risks? How long do I need to be out or work? And so many other questions.
Here is a basic talk I have with my patients when they come and visit me for a consult:

So there is not much more I can tell you about your heart than you already know.  You have coronary artery disease. What it means is the arteries which supply blood to your heart have blockages.  The reason for developing those blockages can be several but these can be divided into 2 broad categories: environmental or genetics reasons.  Environmental reasons include things that you can control, for example smoking, bad eating habits, and not exercising.  Genetic reasons are conditions which may have been passed along from one family member to you.  Mainly from your parents, or an immediate family member, who passed the condition onto you.  Such is the case of many patients suffering of coronary artery disease. Usually you can recall of a family member who suffered or died of a heart attack.

The next question is commonly what to do about it?  I typically answer there are 4 choices to consider.  The first is not do anything.  Remember, if you don't want to do anything that's fine except what we know is people who have coronary artery disease who go untreated can except a shorter life span because of the disease if they compare themselves to treated individuals.  Thus the advantage of doing something is not only to take away the symptoms, but also make you live longer.  
A second alternative is medical therapy in the form of pills.  While medicines are good in alleviating symptoms these cannot take the blockages away.  There is not a magic pill which will dissolve the blockages.  Those blockages stay for the rest of your life.  So to some degree medicines are aimed as to taking away or making your symptoms better. These alone may not prolong your life.
A third alternative are balloons or stents.  These are quite effective in opening obstructed vessels.  But believe me, you wouldn't be seeing a cardiac surgeon if that could have been done.  The majority of interventional cardiologist, and surgeons, understand and know the appropriate criteria for stents.  We wouldn't offer surgery if stents hadn't been considered first.
The final alternative is surgery.  Surgery compared to all of the above is probably the best long term alternative. It can provide symptom relief (quality of life), and prolong someone's life (quantity) for years, even decades.  But the advantages of surgery have to be weighed against the risks.  For patients who have a normal functioning heart and have little, or no additional, diseases which may complicate surgery the risk of dying because of open heart surgery can be calculated to be less than 2 %.  In some cases the risk can be as low as 1%.  Again, it is all dependent on how many other medical problems you have at the time surgery is being considered.
Commonly, the process of surgery takes anywhere from 5 to 6 hours. This is calculated from the time a patients enters the operating room until the time he or she arrives to the intensive care unit.  However, the surgery in itself is more than likely 1.5 hours.  
Most surgeons split the breast bone to do the procedure and take an artery from behind the chest and a vein (or veins) from the leg to perform the bypasses around the blockages.  Remember we don't take the blockages out.  We simply establish a road around the blocakage (a bypass) to get blood to the heart.  Depending on the number of arteries, or branches of arteries, blocked is how the number of bypasses patients will need.
Once the surgery is done, the patient is transferred to the intensive care unit.  Here they may spend a day.  The breathing tube typically comes out during the first 24 hours, and any catheter or chest tube inserted at the time of surgery are commonly removed.
After a day in the intensive care unit most patients get discharged to the telemetry unit where they spend 3 to 4 more days. This period of time is when we help patients transition to a more indepent phase of their care.  During this portion of the post operative period patients are helped to walk, take deep breaths, and transition from intravenous pain medications to oral ones.  
I commonly tell patients once they are able to ambulate independently, eat a regular meal, manage their pain with oral pain medicines and remain without supplemental oxygen they are ready to be discharged home.
We commonly provide an order for the patient to attend cardiac rehabilitation.  This is similar to attending a gym, and frequently it requires 3 visits a week for a period of 6 weeks.  Cardiac rehabilitation is arranged by a Case Manager, who helps the patient find a location close to home to facilitate access to the program.
A patient typically returns to the office for their post operative visits 1 week, 1 month and 3 months after their surgery as part of the regular follow up.  Patients are advised not to drive for a month after surgery or if they are taking any narcotics to ease the pain after surgery.  Most working patients return to work 3 to 5 weeks after open heart surgery as long as they do not do heavy lifting in their jobs.  
I do suggest returning to see their cardiologist during the first post operative month so that their medicines can be adjusted accordingly.