Redo – Mitral valve Replacement Operation
- drpavankumar
- 0
- on Apr 17, 2019
Redo – Mitral valve Replacement Operation
Mr. RW 47yrs old, male had undergone Aortic Valve replacement & Mitral Valve repair heart operation in 2004 by Dr. Pavan Kumar at Lilavati Hospital. This operation was done for his Rheumatic Aortic incompetence (AR) & Mitral stenosis disease, he suffered for 10 years. He received Mechanical Aortic valve prosthesis due to his young age. He did very well following his Aortic valve replacement & Mitral Valve repair surgery. This surgery went very well for last 14 years. Since last 1 year he was feeling breathless on exertion . On regular follow up. His Echocardiography showed that prosthetic Aortic valve was functioning well but Mitral valve showed severe leakage ( regurgitation) with calcification in valve cusps. Due to these findings he was advised replacement 0f damage Mitral Valve.
He was admitted for Redo Mitral Valve replacement at Lilavati Hospital & underwent successful replacement of damaged Mitral Valve by mechanical heart valve prosthesis as he already had Mechanical heart valve at Aortic Valve position. This Redo MVR was carried out by Dr. Pavan Kumar who performed first heart operation on patient in 2004.
Patient was discharged successfully on 7th post op day.
Discussion : 1) Repeat / Redo heart operation are complicated complex operation due to altered heart structure anatomy. All heart chambers & great vessels are adherent due to loss pericardial fluid in first surgery. It is a challenging task to separate out each structure without damaging it & has risk of tear / rupture causing huge blood loss & mortality , expertise & skilled surgery to do this operation is of utmost importance.
2) In this patient choice of prosthetic valve was mechanical as he had undergone Aortic Valve replacement ( AVR) by mechanical valve , so he was on blood thinners/ anticoagulation already.To do repeat surgery on patient with anticoagulation has complications of dangerous bleeding or prosthetic valve clotting when blood thinners are stopped. Fine balancing of anticoagulation protocol & perfect
timing of Redo surgery is a must for blood less field & successful outcome.
3) Tissue valves versus Mechanical Valves.
In this patient, as he had a mechanical heart valve surgery AVR in first surgery was to continue on Anti-coagulation for life, so dicision was taken to replace damaged Mitral Valve with mechanical heart valve prosthesis with higher level of Anti-coagulation for life. Patient has had good 15 yrs successful result of AVR with Mechanical heart valve & he will also has excellent long term result now ( Double Heart Valve Replacement ) heart operation.