Doctors said my heart op would be like fixing a leaky umbrella
NHS surgeons carry out approximately 2,200 mitral valve operations each year. Here, Theresa O’Connor, 49, a community nurse who lives with her husband in Fulham, South-West London, tells ANGELA BROOKS about her mitral valve heart operation and her surgeon
MY HEART valve problems started 12 years ago, on the day I started work as a community nurse. I had palpitations and a very fast heart rate but because I was new I didn’t want to ask for time off.
When I got home I went to lie down but my husband insisted I see our GP. He sent me to Charing Cross Hospital where they did tests and scans and told me I might have a prolapse of the heart’s mitral valve.
I’d heard of people with this condition and although I didn’t know much about it, I knew the valve has two flaps that open and close in response to the heart beat and that a prolapse meant one of the flaps might be sagging, so it wouldn’t close properly, leading to a leaky valve.
I was told the prolapse wasn’t severe — and that they would only consider major surgery if it got worse. But they told me to take a daily aspirin and from then on I was monitored annually, with a scan.
For years after that I was fine although I did sometimes get palpitations. Then two years ago I went in for my regular check and the cardiologist did a trans- oesophageal echogram where they put an ultrasound tube down your gullet which allows them to assess how the valve is performing.
It was at this stage that they told me the valve looked as if it was getting worse because there was more backflow of blood into my heart’s top chamber.
Six months later I was increasingly breathless and tired, even from just walking upstairs, and the palpitations were more noticeable. I realised my heart was labouring and I could tell I wasn’t as fit as I had been.
In March this year after the latest check-up, the cardiologist told me the prolapse was now severe and recommended surgery within the next six months. He referred me to a heart surgeon at the Hammersmith Hospital.
I got an appointment with Mr Prakash Punjabi, two months later. He said the two options for dealing with a mitral valve prolapse was either a valve replacement or repair, and the best option for me, because I was relatively young, would be repair.
I was admitted to Hammersmith for my operation in September and was quite anxious, but the operation went well.
I had nine days in hospital and have been home now for about three months. I still have some discomfort, obviously, because they open up your chest then wire the breastbone back together.
I’ve got an 8in scar running down my breast bone and it’s still a bit red but they used soluble stitches, and it is fading and healing really well.
I have been told it will probably take three months for me to regain my normal energy levels but I have just started on a cardiac rehabilitation programme, involving exercise, relaxation techniques and talks, which has helped boost my confidence.
I’m on Warfarin to thin my blood and paracetamol for pain relief — which I need for the nerve discomfort in my chest where they cut you open. But I am so pleased this is all over and that the operation was successful. THE heart has four valves to regulate blood and ensure it’s kept in the one-way system. A malfunctioning valve can be caused by stenosis which makes it stiff so it doesn’t open properly and by a prolapse when the valve flaps, which open and close every second, become floppy and sag allowing blood to flow backwards.
This is sometimes known as a heart murmur because of the sound it makes when a doctor listens to it on a stethoscope. When it’s caused by an inherited defect — which is common — it is known as floppy valve syndrome.
Mitral valve prolapse is not a sign of serious heart disease and many patients may have a mild prolapse for years without symptoms. Surgeons only consider intervention when it poses a risk of damage to the heart. We don’t take pre- emptive action because this is major heart surgery and it is never undertaken lightly. The preference is always to repair the valve if possible.
Nature’s valve — even a patched one — is vastly superior to mechanical alternatives. A mechanical valve also means putting the patient on blood thinning medication for life so their normal blood clotting is compromised.
To start the operation we slip an ultrasound probe down the patient’s gullet to give us an excellent vantage point for viewing this valve.
Next we split open the breast bone, holding it open with a retractor, then open the sac in which the heart is enclosed.
With this done, the patient is put on the bypass machine which takes over the function of the heart and lungs and helps create a bloodless field for us to work in. Then, through the coronary arteries, we infuse a cocktail of drugs — cardioplegia — which stops the heart and protects it and also makes it easier to re- start once we’ve finished our work.
By making an incision in the left atrium — the upper heart chamber on the left side — we can access the valve. Our repairs will depend on what we find.
The flaps of the mitral valve work almost like an umbrella and are connected to the heart muscle by cords which allow them to open and close in response to the heart contractions. Sometimes they can snap or become baggy.
We prefer to replace the diseased cords — and could be doing up to eight — rather than attempt to repair them, and use synthetic ones made from Gore- Tex which is actually stronger than healthy, natural cords.
With this patient, as is quite common, we also had to cut out a floppy segment in the middle of the rear valve flap, then stitch it together again making it taut once again. Sometimes we also have to strengthen the valve itself.
Once this is done, we test it is working by injecting saline into the chamber to see whether it comes out. If it doesn’t, the valve is doing its job and has been properly repaired. Then we close the left atrium and allow the heart to start beating again.
We pop an ultrasound tube down the patient’s oesophagus to take an echocardiogram of the mitral valve to make sure it is competent, and provided we are happy with that, we then wean the patient off the heart lung bypass. We close the breastbone with special stainless steel wire and use soluble stitches to close the skin.
From the recovery room patients are taken to intensive care where they will be kept closely monitored for the next two days. A seven- day post- operative hospital stay is standard for operations of this sort and patients can expect to be back to normal within three months.
Mitral valve repair costs the NHS about £9,000. Privately it will cost approximately £15,000.