Robotic Mitral Valve Replacement
MEDICAL ANIMATION TRANSCRIPT: If you have a severe problem with the mitral valve in your heart, your doctor may recommend a robotic mitral valve replacement, if it can't be repaired. Your mitral valve is one of the four valves in your heart. It lies between your left atrium, or upper chamber, and left ventricle, or lower chamber. Oxygen-rich blood coming from your lungs goes into the left atrium. When your left atrium contracts, blood flows through your open mitral valve and into your left ventricle. When your left ventricle contracts, your mitral valve closes to prevent blood from flowing back into your left atrium. Your mitral valve has two leaflets an anterior, or front, leaflet, and a posterior, or back, leaflet. String-like tissue, called tendinous cords, attach both leaflets to the inside of your left ventricle. The tendinous cords help prevent blood from flowing back into your atrium. You may have one or both of the two main problems that can happen to your mitral valve. One problem is stenosis, in which the opening in your mitral valve is too narrow. The narrow opening reduces the amount of blood flowing through the valve from your left atrium to your left ventricle. Mitral valve stenosis may be caused by rheumatic fever or heart birth defects. The other problem your valve may have is regurgitation, in which your mitral valve doesn't close completely. Regurgitation allows blood to leak back into your left atrium when your left ventricle contracts. Mitral valve regurgitation may be caused by mitral valve prolapse, in which the valve leaflets and cords become weak and loose; rheumatic heart disease, which may result from rheumatic fever; heart birth defects; or heart enlargement, called dilation, which may result from a heart attack. Both stenosis and regurgitation strain your heart, because it has to pump harder to move oxygen-rich blood to your body. Before your procedure, an intravenous line will be started. You may be given antibiotics through the IV to decrease your chance of infection. You will be given general anesthesia to make you unconscious and pain-free during the procedure. A breathing tube will be inserted through your mouth and down your throat to help you breathe during the procedure. Your surgeon will typically make four or five small incisions on the right side of your chest. An assistant will insert a special camera, called an endoscope, and other tools attached to the robotic arms through the incisions. Unlike standard laparoscopic instruments, these tools can rotate 360 degrees and have more flexibility than a human wrist. Seated at a special console, your surgeon will operate the robotic arms and the camera with joystick-like controls and foot pedals. A computer will translate the exact movements of your surgeon's hands into precise movements of the surgical tools. Your surgeon will have a magnified, three-dimensional, stereoscopic view inside your body through a high-definition vision system. After the robotic arms are in place, you will be placed on a heart-lung machine. This machine will take over the functions of your heart and lungs while your heart is stopped for your operation. Your surgeon will begin the procedure on your heart by making an incision in your left atrium to get to your mitral valve. Next, all of your mitral valve's attachments to your heart will be cut. And the valve will be removed. Your damaged mitral valve may be replaced with an artificial mechanical valve. A mechanical mitral valve will last a lifetime. However, they require you to take a blood thinner medication for the rest of your life. Alternatively, your mitral valve may be replaced with a valve made from human or animal tissue. A tissue mitral valve may not last as long as a mechanical valve. However, the natural tissue does not require blood thinner medication. Once your new valve is in place, your surgeon will restart the beating of your heart, and remove the attachments to the heart-lung machine. At the end of your procedure, your skin incisions will be closed with stitches, staples, surgical glue, or skin closure strips. After your procedure, your breathing tube will be removed, and you will be taken to the intensive care unit, or ICU, for monitoring. You will be given pain medication as needed. You may continue to receive fluids and medications through your IV. You will be given blood thinner medication if you have a mechanical valve. Most patients are released from the hospital about a week after the procedure.