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Mitral Valve Disease Repair and Replacement in India


What Is Mitral Valve Disease
Mitral Valve Stenosis
Mitral Valve Regurgitation
Diagnosis of Mitral Valve Disease
Treatment of Mitral Valve Disease
Surgery for Mitral Valve Disease
Surgery to Treat Mitral Regurgitation
Surgery to Treat Mitral Valve Stenosis


What Is Mitral Valve Disease

Heart Specialists at We Care partner hospitals in India are among the most experienced in the country in treating mitral valve disease, evaluating thousands of patients each year. Patients benefit from our partner hospitals state-of-the-art facilities, leading-edge medical treatment, and access to clinical trials and new treatments for the disease.

Heart surgeons in India are renowned for their experience and expertise in repairing and replacement of mitral heart valves. In some cases, surgery can be done with minimally invasive techniques, including robot-assisted surgery, that can result in significantly less pain and recovery time for patients.


Mitral Valve Stenosis

Mitral valve stenosis, (mitral stenosis) is a narrowing of the mitral valve. With narrowing, the valve does not open properly and obstructs blood flow between the left chambers of the heart.

Mitral Valve Replacement Surgery, Mitral Valve Repair India

[ Mitral Valve Stenosis ]


If not treated, mitral stenosis can weaken the heart, lead to heart failure or heart enlargement, and cause irregular heartbeats. Other potentially serious complications can include stroke, heart infection, pulmonary edema (water on the lungs) and blood clots.

Within a few days, a team of heart valve disease specialists at from We Care coordinates the patient's care to provide a complete examination, diagnosis and extensive patient education. These specialists see patients ranging from those who might want to have a heart murmur checked, to those who have been told they have advanced mitral heart valve disease.

If surgery is indicated, a cardiac surgeon meets with the patient to thoroughly discuss surgical options and, in most cases, can perform the surgery the following day - depending on the patient's preference.

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Symptoms of Mitral Valve Stenosis : -

Signs and symptoms of mitral stenosis depend on how severely and quickly the condition develops. Some people never develop symptoms

Some have mild problems that suddenly get worse. Signs and symptoms of mitral stenosis include : -


  • Shortness of breath, especially with physical exertion (exercise) or when the person lies down
  • Fatigue, especially during increased activity
  • Swollen feet or ankles
  • Heart palpitations - sensations of a rapid, fluttering heartbeat
  • Dizziness or fainting spells
  • Frequent respiratory infections, such as bronchitis
  • Heavy coughing, sometimes with blood-tinged sputum
  • Rarely, chest discomfort or chest pain


Causes of Mitral Valve Stenosis : -

The mitral valve can narrow because of conditions that include : -


  • Rheumatic fever : - In some people, the body's response to the strep throat infection leads to mitral valve damage that causes the valve to become inflamed, thicken, and leak (mitral regurgitation). This inflammatory process can cause the valve to fuse and harden, resulting in mitral stenosis. People who have had rheumatic fever may have both mitral stenosis and mitral regurgitation.


  • Congenital heart defect : - Some infants are born with a narrowed mitral valve and develop mitral stenosis early in life. Babies born with this problem usually require heart surgery to fix the valve. Others are born with a malformed mitral valve and have a risk of developing mitral stenosis when they're older.

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Mitral Valve Regurgitation

Mitral valve regurgitation, or mitral regurgitation, occurs when the mitral valve doesn't close tightly and blood flows backward in the heart. Mitral regurgitation from mitral valve prolapse is the most common reason for surgical treatment. If not treated, mitral valve regurgitation can lead to congestive heart failure. Treatment depends on the severity of regurgitation, how far mitral valve disease has progressed, and signs and symptoms of the disease.


Symptoms of Mitral Valve Regurgitation

Signs and symptoms of mitral regurgitation depend on how severely and quickly the condition develops. Most often, mitral regurgitation is mild, and severe mitral regurgitation develops slowly. If no symptoms develop for decades, the patient may not know the condition is present.

Signs and symptoms can develop gradually because, for some time, the heart can compensate for the defect. The first notable sign is usually an abnormal sound, or heart murmur. Sometimes, however, the disorder develops quickly, and the patient may experience the abrupt onset of more severe signs and symptoms.

Indicators of mitral regurgitation include : -


  • Shortness of breath, especially with physical exertion or when the person lies down
  • Fatigue, especially during increased activity
  • Cough, especially at night or when lying down
  • Awakening at night with shortness of breath
  • Heart palpitations - sensations of a rapid, fluttering heartbeat
  • Swollen feet or ankles


Causes of Mitral Valve Regurgitation

Any condition that damages the mitral valve can cause regurgitation, including : -


  • Mitral valve prolapse

    Mitral regurgitation from mitral valve prolapse is the most common reason for surgical treatment. Mitral valve prolapse occurs when the leaflets and supporting cords of the mitral valve have excess tissue, and they weaken. With each contraction of the left ventricle, the valve leaflets bulge (prolapse) into the left atrium. This common heart defect may prevent the mitral valve from closing tightly and lead to regurgitation. Mitral valve prolapse is common. Many who have it never develop severe regurgitation.


  • Damaged cords

    Mitral regurgitation may result from damage to the cords that anchor the flaps of the mitral valve to the heart wall. Over time, these cords may stretch or suddenly tear, especially in people who have mitral valve prolapse. A sudden tear can cause substantial leakage through the mitral valve. Repair may involve emergency heart surgery.


  • Deterioration of the valve with age

    The mitral valve opens and shuts tens of thousands of times a day. Age-related wear and tear on the valve can lead to mitral regurgitation. Our partner hospitals have extensive experience in successfully treating elderly patients who have mitral regurgitation.


  • Prior heart attack

    A heart attack can damage the area of the heart muscle that supports the mitral valve, affecting the function of the valve. If the damage is extensive enough, a heart attack may result in sudden and severe mitral regurgitation.


  • Endocarditis

    The mitral valve can be damaged by endocarditis - an infection inside the heart that can involve the heart valves. Read more about endocarditis prevention.


  • Congenital heart defect

    Some infants are born with defects in their heart, including a leaking mitral valve.

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Diagnosis of Mitral Valve Disease

Diagnosis begins with a complete physical examination by a team of heart specialists. Patients will be asked about their general health, including signs and symptoms of potential problems, and whether their family has a history of heart disease. Tests listed below may be used to determine the possible cause of a heart valve defect, the severity of the problem, and whether the mitral valve must be surgically repaired or replaced. Specialists trained and experienced in the various diagnostic procedures perform these tests.


Chest X-ray

An X-ray image of the chest shows the physician the size and shape of the heart and whether the heart's left atrium (upper left chamber) and/or left ventricle (lower left chamber) are enlarged - a possible sign of a damaged mitral valve. By viewing a chest X-ray, the physician can also evaluate the lungs. A damaged mitral valve may result in blood backing up into the lungs. Congestion is visible on an X-ray.


Electrocardiogram (ECG)

An ECG provides information about heart rhythm and, indirectly, heart size. With mitral valve disease, the heart's left atrium (upper left chamber) and left ventricle (lower left chamber) may be enlarged, and heart rhythms may be irregular (arrhythmias).


Echocardiogram (Doppler Echocardiogram)

Sound waves produce detailed images of the patient's heart. Transmitted through a wandlike device (transducer) held on the patient's chest, sound waves bounce off the heart and are reflected back through the chest wall. The sound waves are processed to produce video images of the heart and a close look at the mitral valve. A Doppler echocardiogram may be used to measure the volume of blood flowing backward through the mitral valve.


Transesophageal Echocardiogram

During this test, somewhat similar to an echocardiogram, a tiny transducer (sound device) is inserted into the mouth and down the esophagus, which extends behind the heart. This test provides an even more detailed image of the mitral valve and blood flow through the valve.


Exercise Tests

Different exercise tests can help measure the patient's tolerance for activity and check the heart's response to physical exertion (exercise).


Cardiac Catheterization

A thin tube (catheter) is inserted into a blood vessel in the patient's arm or groin and threaded up to the heart. The catheter is used to deliver dye into the heart chambers and heart blood vessels. The dye, appearing on X-ray images as it moves through the heart, shows physicians detailed information about the heart and heart valves.


Computed Tomography (CT)

A CT scan uses a series of X-rays to create a detailed image.

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Magnetic Resonance Imaging (MRI)

An MRI uses powerful magnets and radio waves to create a detailed image.


Holter Monitor

A patient wears this portable device to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect intermittent heart rhythm irregularities that may be associated with mitral valve disease.


Electrophysiology (EP)

For patients with irregular heart beats, We Care partner hospitals provide electrophysiology assessments. These tests are performed by electrophysiologists and cardiologists trained in the diagnosis and treatment of heart rhythm disorders, including those caused by heart valve defects. We Care partner hospitals in India have the latest technology to analyze and record heart rhythms. Other tests at We Care partner hospitals in India use nuclear medicine (radioactive materials) for detailed imaging and advanced analysis of the heart and heart valves.


Treatment of Mitral Valve Disease

Treatment options for mitral valve disease can include : -


  • Careful Monitoring : - If tests reveal a mild to moderate condition and the patient has no symptoms, the physician might suggest regular medical checkups to carefully monitor the mitral valve.


  • Medications : - Medications can help reduce the heart's workload and regulate its rhythm. In some cases, medication can slow progressive mitral valve disease. However, no medications can cure heart valve disease.


Surgery for Mitral Valve Disease in India

At some point, the risks from a leaking or narrowed heart valve (including blood clots, heart enlargement, stroke, and heart failure) become greater than the risks of surgery to fix the problem. We Care partner cardiovascular experts assess these risks and advise patients if and when surgery is necessary. We Care Partner surgeons have extensive experience and a strong record of excellence in heart valve repair and replacement.


When is Surgery Needed ?

The most common reason for mitral valve surgery is regurgitation (leakage) due to mitral valve prolapse and other causes. Valves with regurgitation are usually repairable and rarely require replacement.

The other main reason for surgery is mitral valve stenosis (narrowing). Usually, narrowed valves require replacement. We Care partner hospitals offer minimally invasive heart surgery options for both surgeries.

Cardiovascular surgeons generally agree that, whenever possible, a heart valve should be repaired instead of replaced. Heart valve repair leaves patients with their own normally functioning tissue, which is resistant to infection and does not require taking blood-thinning medication.

In some cases, such as with valves damaged by rheumatic heart disease, the valve may be too damaged and must be replaced with a prosthetic (artificial) valve.

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Surgery to Treat Mitral Regurgitation - Mitral Valve Repair in India

Surgery to fix leaking (regurgitation) due to mitral valve prolapse (bulge due to weakening) depends on the prolapse's location. The mitral valve is a bileaflets valve; it has two flaps or leaflets: posterior and anterior

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Prolapsing mitral valve repair Annuloplasy band added
for protection

If the prolapse occurs on the posterior leaflet, We Care partner surgeons repair it by removing a section from the bulging area, sewing the cut edges back together, and sewing an annuloplasty band into the posterior section of the annulus (ring of fibrous tissue surrounding the leaflets) to reduce its circumference and ensure that the leaflets close properly. The durability of this repair is very good; only about 0.5 percent of patients per year require a second surgery.

If the prolapse occurs on the anterior leaflet, the approach is to replace a torn or stretched-out supporting cord (chordae tendinae) with an artificial cord (neochordae) to better anchor the leaflet to the heart wall. Sometimes a section from the bulging area is also removed.

As in repair to a posterior leaflet, an annuloplasty band is added for additional support. If prolapse occurs on both leaflets (bileaflet), a combination of these techniques may be used.


Surgery to Treat Mitral Valve Stenosis in India

Surgery to eliminate mitral valve stenosis is sometimes accomplished by surgically separating or shaving back the valve leaflets (called commissurotomy). However, most patients with narrowed mitral valves require valve replacement.


Mitral Valve Replacement

Mitral valve replacement involves replacing the defective valve with a prosthetic (artificial) valve that is sewn to the annulus of the natural valve. Two kinds of replacement valves are available:


Mechanical valves

Mechanical valves made of synthetic materials are reliable and long-lasting. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves need to take blood-thinning medicines (anticoagulants) for the rest of their lives.


Biological valves

Biological valves are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft/Ross procedure). Patients with biological valves usually do not need to take blood-thinning medication. However, these valves are not as durable as mechanical valves and may need to be replaced. Biological valves are used most often in elderly patients.

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Minimally Invasive Robotic Mitral Valve replacement of repair surgery in India

By applying advanced endoscopic and robotic technology, cardiovascular surgeons at We Care partner hospitals in India are performing an ever-growing number of heart surgeries with minimally invasive techniques. We Care partner hospital is one of only a few centers in the India experienced in performing minimally invasive heart surgery in children.

Our partner surgeons use two minimally invasive surgery methods: robot-assisted (the da Vinci system) and thorascopic. Both approaches access the heart through small incisions in the right chest wall and avoid having to split the breastbone (sternotomy).

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Minimally invasive surgery approaches the heart from the side

Avoiding sternotomy reduces pain and recovery time for most patients, enabling them to resume normal daily activities sooner. Minimally invasive surgery also leaves smaller, less-noticeable scars than open heart surgery, has a lower risk of infection, and may involve less blood loss.

Besides reducing trauma for the patient, minimally invasive surgery also allows the surgeon a better view of some parts of the heart anatomy than the view with open heart surgery.

Minimally invasive heart surgery still requires that blood flow be diverted from the heart, and the heart must be stopped with cardiopulmonary bypass.

Minimally invasive surgery may be used to treat congenital (present at birth) heart problems or those that have developed later in life. Minimally invasive surgical procedures that We Care partner hospitals in India include Mitral Valve repair and replacement surgery.


The list of of world class heart hospitals in India is as follows : -


Apollo Hospitals Bangalore Apollo Hospitals, Bangalore, India
Apollo Hospital Chennai Apollo Hospital, Chennai, India
Apollo Hospitals Hyderabad Apollo Hospitals, Hyderabad, India
Apollo Hospitals Delhi Indraprastha Apollo Hospital, Delhi, India
Apollo Hospitals Kolkata Apollo Gleneagles Hospital, Kolkata, India
Wockhardt Hospital Bangalore India Wockhardt Hospital, Bangalore India
Wockhardt Hospital hyderabad, India Wockhardt Hospital, hyderabad, India
Wockhardt Hospital Mumbai, India Wockhardt Hospital, Mumbai, India
Fortis Hospital, Delhi, India Fortis Hospital, Delhi, India
Fortis Hospital Mohali, India Fortis Hospital, Mohali, India
Fortis Hospital Noida, India Fortis Hospital, Noida, India
Escorts Heart Institute Hospital, Delhi, India Escorts Heart Institute Hospital, Delhi, India
Narayana Hrudayalaya Heart Hospital, Bangalore, India Narayana Hrudayalaya Heart Hospital, Bangalore, India
Artemis Hospital, Gurgaon ( Delhi ) , India Artemis Hospital, Gurgaon ( Delhi ) , India
Max Devki Devi Heart and Vascular  hospital,  Delhi, India Max Devki Devi Heart and Vascular hospital, Delhi, India
BGS Global Hospital Bangalore, India BGS Global Hospital, Bangalore, India
BGS Global Hospital Chennai, India BGS Global Hospital, Chennai, India
BGS Global Hospital Hyderabad, India BGS Global Hospital, Hyderabad, India


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