The letter M shows the position of the mitral valve in the heart
In mitral stenosis there is restriction of the valve opening thereby making it difficult for blood to flow through the heart
DIAGNOSES-OPERATIONS
 

MITRAL VALVE STENOSIS

The revolution in heart valve operations has come from the advent of the Heart Team, a group of specialized physicians dealing with all aspects of the heart – cardiac surgeons, interventional cardiologists, echocardiographers, cardiac anesthesiologists, vascular surgeons and cardiac radiologists.  This team analyzes all of the patients data and recommends a solution that is customized for the specific patient.  The heart team at HYGEIA Hospital is one of the few teams worldwide that performs operations that are cutting-edge, oftentimes with technology that is not available to all physicians (in the setting of a clinical trial).  This gives us the opportunity to provide solutions for patients who have been told that they are inoperable. 

Of paramount importance is the unique Hybrid Operating Room at HYGEIA Hospital which is the first in Greece. The Hybrid Operating Room is an operating room of the highest technological specifications which is modified to be able to carry out both classic “open” operations as well as endovascular and transcatheter operations which are performed with a simple needlestick and without any incisions.  

Dr. Pattakos is the co-organizer of the well-known conference “Transcatheter Heart Valves Greece” which is attended by international experts in cardiology and cardiac surgery to discuss the latest developments regarding heart valves.  For further information please visit www.thvgreece.com

VALVE REPAIR OR VALVE REPLACEMENT?
Heart valve operations are divided into those which repair the valve and those which replace the valve if it cannot be repaired.  The anatomic characteristics of each valve help the surgeon decide which of the two choices is best for each patient.

SELECTION OF MECHANICAL OR BIOLOGICAL VALVE
For patients who require a valve replacement there is a choice to be made about whether to receive a mechanical (also known as metallic) valve or a biological valve. 
A mechanical valve can function for multiple decades but the drawback is that patients require blood thinners.  The patient who takes these blood thinners requires frequent laboratory evaluation of their levels.  They must also eat stable quantities of foods that contain Vitamin K as this vitamin influences the clotting process. There is also an estimated 1-2% risk of clotting of the valve or bleeding anywhere in the body.

Biological valves do not require blood thinners but they have an approximately ten year lifespan (longer for older patients and shorter for younger patients). When the valve starts to dysfunction this usually happens gradually and patients perceive symptoms and must usually receive a second operation.  This second operation can be performed either with open surgery or, in some cases, with a catheter using a small puncture in the groin.  

WHAT IS IT?
The mitral valve controls flow of the blood from the lungs and left atrium towards the left ventricle which will in turn pump the blood out to the rest of the body. In mitral valve stenosis the blood cannot easily cross the valve towards the left ventricle and pressure builds up in the left atrium thereby increasing pressures in the lungs as well.

WHAT ARE THE CAUSES?
The most common cause of mitral stenosis is rheumatic fever due to infection with streptococcus. Other causes include calcification of the valve where calcium salts build up, congenital (since birth) anatomical variations, radiation therapy for cancer as well as certain autoimmune diseases. 

SYMPTOMS
The symptoms may include easy fatigue, heart fluttering, or difficulty breathing because of the increases pressure in the lungs (there may even be pink fluid or blood that the patient spits out).

OPERATION
In certain cases the valve may be repaired but most often replacement is necessary.  The choice is between a mechanical valve and a biological valve and placement may be performed with less invasive options such as thoracoscopically with use of a camera and tiny “keyhole” incisions. Treatment may occasionally also be offered with a catheter through a small groin puncture. 
Attending Surgeon 2nd Department of Cardiac Surgery
Assistant Director Division of Transcatheter Heart Valves
HYGEIA HOSPITAL

Erithrou Stavrou 4, Marousi
210 6867639, 210 6867640
gregpattakos@yahoo.com
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