The title seems like quite a mouthful so let’s break this down into the components and look at just what minimally invasive mitral surgery actually is.
The mitral valve connects the left atrium to the left ventricle and it has the job of controlling the flow of blood, so it cannot flow back into the atrium when the lower ventricle contracts to expel the blood from the heart, and send it on its journey back around your body. The mitral valve itself is comprised of a connection between the two chambers which is open when blood flows from the atrium into the ventricle, but which must be closed when the ventricle then contracts. The opening is closed by means of two, parachute like leaflets which are attached to the inner wall of the heart by means of cords (known as chordata) – the force of blood being compressed and looking for a way out of the heart forces the leaflets to deploy and block the mitral valve opening.
If the mitral valve fails to operate properly, blood can flow back into the atrium and this is known as “mitral regurgitation” which may result in pooling of blood in the heart, leading to the formation of blood clots. Blood clots are the cause of strokes and may also lead to other serious cardiac episodes, both of which may be fatal.
In addition, the mitral valve may become thickened and restrict the supply of blood or enflamed which affects the structures allowing the valve to operate. This is known as “mitral stenosis”.
Mitral valve disease may result due to bacterial infection or other underlying cardiac disease but the majority of patients who suffer the condition acquire it as a result of hereditary factors and it is common to find the disease running in families.
Traditionally, surgery was open heart which involves a large scar due to the chest incision and “rib cracking”; the spreading of the ribs to expose the heart to allow the surgeon to operate. This procedure results in considerable pain levels, extended stays in hospital and post operative recovery periods though the surgery has extremely high levels of success in both immediate results and long term prevention of the recurrence of the disease.
Medical advances in technique and technology have led to the development of minimally invasive surgery. By minimally invasive, we mean that there is less cutting and internal intervention; in simple terms it means smaller incisions and less intrusion into the chest cavity while seeking to handle only those organs and tissues which need the surgeon’s attention. Some techniques involve the use of robotically assisted instruments to provide for greater precision and control when handling the specific tissue and structures which are the subject of the surgery.
Minimally invasive techniques require a much higher degree of surgical skill and expertise and there are additional risks associated with using these techniques though the success rates are still very high. In addition, there are benefits to using the procedures because they result in reduced pain for the patient and much shorter stays in hospital and recovering from the surgery. There is also much less scarring and incisions are made at other locations on the body which result in operation scars being far less visible which makes for a far better cosmetic effect.
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