A new phase of heart valve repair and replacement surgery with the use of endoscopic procedure, leaves a small incision about 4-5 cm, provides faster recovery and fewer nights of hospital admission, allow patients to return to the life they were previously familiar with within 1 month.
The heart is responsible for pumping blood to rest of the body for the organs to function properly. There are 4 heart valves, known as Tricuspid valve, Pulmonary valve, Mitral valve, and Aortic valve. These heart valves control blood flow in 4 chambers of the heart to keep the circulation in right direction and prevent blood flowing backwards. If the valves are damaged, deteriorated or their functions are affected by any disease that led to an abnormality, it will cause the muscles of the heart to work harder and eventually result in certain conditions, i.e., enlarged heart, cardiac or pulmonary hemorrhage or heart failure that could be life threatening
Dr. Siam Khajarern, specialized in Cardiothoracic Surgery at Vejthani Hospital reveals the causes of abnormalities in heart valves as follows:
- Degenerative Valve Disease: Often found in elderly, causes by the degeneration of valve tissues
- Rheumatic Heart Disease: Caused by group A Streptococcus infection that results in rheumatic fever, which damages the valves in long term. The symptoms of heart abnormality often appear after 5-10 years of rheumatic fever.
- Infective Endocarditis: Caused by an infection in the bloodstream and bacteria that enters and settle in the valves, resulting in patients to develop acute illness and severe heart failure.
- Myocardial Infarction: May cause Mitral valve leakage.
- Congenital Valve Disease: Often occurs before birth, lead to an abnormal growth of the heart valves.
“Valvular disease is classified as two different types; Valve Stenosis and Valve Regurgitation, which can occur in all four valves. Often times, patients with heart valve disease have the tendency to feel tired, have chest tightness, palpitations, irregular heartbeats, and swollen feet. It is vital for the patients to seek immediate medical attention to diagnose and received proper treatment. If the symptoms have not progressed to a severe stage, doctors may prescribe oral medications and make periodic appointments to follow up on the condition. In the case of severe illness, heart valve repair or replacement surgery will be necessary,” said Dr. Siam.
The standard method of heart valve repair or replacement surgery is done by making a vertical incision along the sternum or breastbone, also known as Median sternotomy. Doctors will then break the breastbone apart to access the valve for repairs. This leaves a large scar in the chest and requires long period of recovery time up to 3 months until the breastbones are reattached. Then patients are able to return to their normal life. This method is suitable for those who need heart valve surgery along with other procedures. In present days however, Minimally Invasive surgery or MIS is used with the help of endoscopic procedure which can be performed to repair or replace the heart valves. The potential benefits of Minimally Invasive heart valve surgery include, less blood loss during the surgery, have small incision, breaking breastbones is not required, shorter hospital admission, faster recovery, and patients are able to return to the life they were previously accustomed to within a month or over a month, depending on their physical strength.
“Minimally invasive heart valve surgery can be performed on all 4 heart valves, whether it being a repair or a replacement surgery. The operation will have a primary incision about 4-5 cm long, hidden under the breastbone or in the center of the chest, depending on the location of the valve that needs to be repaired or replaced. Two punctured scars will also be left on the side of the chest with 0.5 cm wide and one scar in the groin, around 2 cm long for catheter insertion for your heart to function during the surgery. I have used this technique to operate on patients from age 18 up to 89. Even if some of them have underlying diseases alongside, such as diabetes, blood pressure, cholesterol, liver disease or chronic renal failure, they can undergo minimally invasive procedure as well,” explained Dr. Siam. Moreover, MIS can be used to perform on atrial septal defect surgery as well as heart repair surgery on two valves at the same time. However, there is a limitation in minimally invasive heart surgery. It cannot be conducted on patients who required other procedures alongside, such as heart valve surgery along with coronary bypass, or heart valve surgery and aortic aneurysm surgery at the same time. Thus, it is crucial for patient to receive definitive diagnosis and to be under the assessments of the specialists.
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