Complex Mitral Valve Repair for young Lady: 34 year’s old lady patient visited the Saudi German Hospital last year seeking medical advice for advanced Heart problems. She was diagnosed early this year with severe Mitral Valve insufficiency affecting her daily activity causing severe shortness of breath on MILD activity and enlargement of heart cavities.
Patient opted for the surgery to be done in her home country. After coming back and a long recovery process she noticed that her condition did not really improve so she visited the Head of Cardiac Surgery Department at Saudi German Hospital.
The heart echocardiography showed severe Mitral valve regurgitation (a condition where the mitral valve leaks and blood flows the wrong way) and the need for a second surgery which was confirmed by medical Team of the Heart Center at SGH which includes two open heart surgery consultants and three interventional Cardiologists. The option to perform the second open heart surgery within 6 months of the first surgery was not easy neither for the patient nor for the surgical Team since a second operation within this short time can be highly complicated. But it was the only available way to improve the clinical condition and long term survival chance of the patient. The mitral valve is a small flap in the heart that stops blood flowing the wrong way. Mitral regurgitation can affect how blood flows around the body. This condition can be corrected by mitral valve repair (which was performed in the first surgery) or mitral valve replacement. Mitral valve replacement is an operation to replace mitral valve with a man-made one (a mechanical valve) or one made from animal tissue (a bioprosthetic valve). Patient needs to take blood thinner (warfarin) for life. Since warfarin is toxic for the embryo and our patient is a young lady, and keen to get pregnant giving this option was not a favorable choice for her.
The second choice is a Mitral valve repair which is an operation to make the flaps of the mitral valve stay closer together. This will help stop blood flowing the wrong way through the valve. Since this method is complicated and has been done during the first surgery, the chances to succeed are markedly less. Dr. Basem Duwederi (HOD Cardiothoracic Department) performed a complex re-operation and was successful in repairing the native valve. In the first Surgery a quadric resection of posterior leaflet MVL with implantation of 28mm ring was done. In the second Surgery almost all Chordae of the anterior and posterior leaflets were replaced with artificial chordae and 3 clefts were closed. The patient was discharged from ICU after 3 Days and from Hospital after 8 days of Surgery and recovered completely. The post-surgery heart scan shows excellent result almost without any valve insufficiency. The follow up scan after 9 months also showed excellent midterm results. The complication rates by doing Re-operation is 3 times higher than normal surgeries, doing this in the first 6 to 12 month will increase the risk even more so it can only performed by highly equipped surgical theatre and qualified surgeons. The second surgical repair after failed first repair is very rare and can only be performed by few distinguished centers worldwide. By keeping her native valve she can now get pregnant without any further Risk.