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| {{Mitral regurgitation surgery}} | | __NOTOC__ |
| '''For the WikiPatient page for this topic, click [[Mitral valve surgery (patient information)|here]]'''
| | {| class="infobox" style="float:right;" |
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| '''For the main page of mitral regurgitation, click [[Mitral regurgitation|here]]''' | | | [[File:Siren.gif|30px|link=Mitral regurgitation resident survival guide]]|| <br> || <br> |
| | | | [[Mitral regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]; {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | | |} |
| [[Image:250px-Diagram_of_the_human_heart_(cropped).svg.png|right|frame|Anterior (frontal) view of the opened heart. White arrows indicate normal blood flow. (Mitral valve labeled at center right.)]]
| | {| class="infobox" style="float:right;" |
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| | | [[File:Critical_Pathways.gif|88px|link=Mitral regurgitation critical pathways]]|| <br> || <br> |
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| | {{Mitral regurgitation}} |
| | {{CMG}}; {{AE}} [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. |
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| ==[[Mitral regurgitation surgery overview|Overview]]== | | ==[[Mitral regurgitation surgery overview|Overview]]== |
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| ==Treatments for Mitral valve regurgitation==
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| The choice of treatment depends on the symptoms present and the condition and function of the heart. Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.
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| [[Anticoagulant]] or [[antiplatelet]] medications (blood thinners) may be used to prevent clots from forming in patients with [[atrial fibrillation]].
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| [[Digitalis]] may be used to strengthen the heartbeat, along with [[diuretics]] (water pills) to remove excess fluid in the lungs.
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| A low-sodium diet may be helpful. Most people have no symptoms; but if a person develops symptoms, activity may be restricted.
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| Hospitalization may be required for diagnosis and treatment of severe symptoms. Surgical repair or replacement of the valve is recommended if heart function is poor, symptoms are severe, or the condition gets worse. Once the diagnosis of mitral regurgitation is made, the patient should have regular follow-ups with a specialist to determine whether he or she need surgery.
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| In the past, patients with heart valve problems such as mitral regurgitation were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart valve. However, antibiotics are now used much less often before dental work and other procedures.
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| ==[[Mitral regurgitation surgery indications|Indications]]== | | ==[[Mitral regurgitation surgery indications|Indications]]== |
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| ==[[Mitral regurgitation surgery recovery|Recovery]]== | | ==[[Mitral regurgitation surgery recovery|Recovery]]== |
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| ==Surgical outcome== | | ==[[Mitral regurgitation surgery prognosis|Outcomes & Prognosis]]== |
| The results of mitral valve repair are excellent in the centers that regularly perform this surgery.
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| Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most patients, and they reduce recovery time and pain.
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| '''Valve repair versus valve replacement'''
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| Advantages of [[Mitral valve repair]] include:
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| *Lower operative mortality rate <ref name="pmid9918527">{{cite journal| author=Tribouilloy CM, Enriquez-Sarano M, Schaff HV, Orszulak TA, Bailey KR, Tajik AJ et al.| title=Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications. | journal=Circulation | year= 1999 | volume= 99 | issue= 3 | pages= 400-5 | pmid=9918527 | doi= | pmc= | url= }} </ref><ref name="pmid3769948">{{cite journal| author=Krayenbuehl HP| title=Surgery for mitral regurgitation. Repair versus valve replacement. | journal=Eur Heart J | year= 1986 | volume= 7 | issue= 8 | pages= 638-43 | pmid=3769948 | doi= | pmc= | url= }} </ref>
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| *Improves left ventricular [[EF]] and function <ref name="pmid7850937">{{cite journal| author=Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL| title=Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. | journal=Circulation | year= 1995 | volume= 91 | issue= 4 | pages= 1022-8 | pmid=7850937 | doi= | pmc= | url= }} </ref>.
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| *Preserves native heart valve and avoids the use of a prosthetic heart valve with its complications.
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| *Has good overall outcome with good survival rates <ref name="pmid9129898">{{cite journal| author=Lee EM, Shapiro LM, Wells FC| title=Superiority of mitral valve repair in surgery for degenerative mitral regurgitation. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 4 | pages= 655-63 | pmid=9129898 | doi= | pmc= | url= }} </ref><ref name="pmid11568020">{{cite journal| author=Mohty D, Orszulak TA, Schaff HV, Avierinos JF, Tajik JA, Enriquez-Sarano M| title=Very long-term survival and durability of mitral valve repair for mitral valve prolapse. | journal=Circulation | year= 2001 | volume= 104 | issue= 12 Suppl 1 | pages= I1-I7 | pmid=11568020 | doi= | pmc= | url= }} </ref><ref name="pmid12835220">{{cite journal| author=Thourani VH, Weintraub WS, Guyton RA, Jones EL, Williams WH, Elkabbani S et al.| title=Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting. | journal=Circulation | year= 2003 | volume= 108 | issue= 3 | pages= 298-304 | pmid=12835220 | doi=10.1161/01.CIR.0000079169.15862.13 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12835220 }} </ref>.
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| *Lower risk for [[endocarditis]].
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| *Avoids long term use of [[anticoagulants]].
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| '''Mechanical versus Biological valves'''
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| Mechanical heart valves do not fail often. They last from 12 to 20 years. However, blood clots develop on them. If a blood clot forms, the patient may have a stroke. Bleeding can occur, but this is rare.
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| [[Biological]] valves tend to fail over time <ref name="pmid8469251">{{cite journal| author=Hammermeister KE, Sethi GK, Henderson WG, Oprian C, Kim T, Rahimtoola S| title=A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 18 | pages= 1289-96 | pmid=8469251 | doi=10.1056/NEJM199305063281801 | pmc= | url= }} </ref><ref name="pmid11028464">{{cite journal| author=Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH| title=Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. | journal=J Am Coll Cardiol | year= 2000 | volume= 36 | issue= 4 | pages= 1152-8 | pmid=11028464 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11028464 }} </ref>, but they have a lower risk of blood clots.
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| ==Possible complications==
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| '''Risks for any surgery'''
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| *Blood clots in the legs that may travel to the lungs.
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| *Blood loss.
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| *Breathing problems.
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| *Infection, including in the lungs, kidneys, bladder, chest, or heart valves.
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| *Reactions to medicines.
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| '''Possible risks from having open-heart surgery'''
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| *[[Heart attack]] or stroke.
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| *Heart [[rhythm]] problems.
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| *Infection in the cut, which is more likely to happen in people who are obese, have [[diabetes]], or have already had this surgery.
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| *Memory loss and loss of mental clarity, or "fuzzy thinking."
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| *[[Post-pericardiotomy syndrome]], which is a low-grade fever and chest pain. This could last for up to 6 months.
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| '''Prosthetic heart valves are associated with a variety of complications'''
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| *Structural deterioration, particularly with bioprosthetic valves.
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| *Valve obstruction due to [[thrombosis]] or pannus formation.
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| *Systemic [[embolization]].
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| *Bleeding.
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| *[[Endocarditis]] and other infections.
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| *Left ventricular systolic dysfunction, which may be preexisting.
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| *[[Hemolytic anemia]].
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| ==Videos==
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| *'''Minimally invasive mitral valve surgery''' (Right thoracotomy approach video)
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| <youtube v=EnJQh_W3r3A/>
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| *'''Robotic mitral valve repair surgery animation-(1)'''
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| <youtube v=VrIxRfWDOm8/>
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| *'''Robotic mitral valve repair surgery animation-(2)'''
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| <youtube v=GYAmSH2zwic/>
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| ==External links==
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| http://en.wikipedia.org/wiki/Mitral_valve#cite_note-0
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| http://www.nlm.nih.gov/medlineplus/ency/article/000176.htm
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| http://www.nhlbi.nih.gov/health/health-topics/topics/hs/before.html
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| http://www.mayoclinic.org/mitral-valve-disease/
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| http://www.nlm.nih.gov/medlineplus/ency/article/007411.htm
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| http://www.nhlbi.nih.gov/health/health-topics/topics/hs/during.html
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| http://www.nhlbi.nih.gov/health/health-topics/topics/hs/after.html
| | ==[[Mitral regurgitation surgery complications|Complications]]== |
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| ==References== | | ==[[Mitral regurgitation surgery videos|Videos]]== |
| {{reflist|2}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
