Is the heart valve stuck? Let's talk about 'Commissurotomy' surgery (Surgical Mitral Commissurotomy)

Do you sometimes feel shortness of breath or a feeling of heaviness in your chest when you are a little tired, or when you climb stairs? Perhaps your doctor has told you about a problem with a valve in your heart. When a heart valve does not open properly and becomes blocked, we call it 'stenosis'. Today we are going to talk about a special surgery that is performed as a treatment for such a condition. Since this is a very important topic, let's understand everything simply.

Simply put, what is this 'commissurotomy'?

Okay, let's first understand this simply. Your heart has four main chambers. Think of them as four rooms. In order for blood to flow from one chamber to the next, the doors between them have to open and close properly. Those doors are what we call heart valves .

A commissurotomy is a procedure that involves the mitral valve in your heart. It is located between the two chambers of the heart, the left atrium and the left ventricle. This is the door between the two chambers. This door has two flaps.

Due to certain medical conditions, especially a condition called 'Mitral Valve Stenosis' , these two doors don't open properly. It's like a stuck door. What happens then? The flow of blood from the upper chamber to the lower chamber is reduced. This causes the blood to back up, putting a lot of strain on the heart and lungs. Over time, this can lead to serious conditions like heart failure .

Who really needs this surgery?

This surgery is not for everyone. There are several main reasons why your doctor may recommend this surgery:

• If other treatments (such as medication) you have been given have not had a successful outcome.
• If you are not suitable for a procedure called 'Balloon Valvuloplasty', which involves widening the valve with a balloon.
• If you have another heart surgery, you can have this surgery at the same time.

But the most important thing is that the success of this surgery depends on the cause of your mitral valve stenosis. Let's look at the two main causes.

What does it mean when valve covers stick?

This is very easy to understand. Imagine that you are smiling in front of a mirror with your lips closed. Look at the corners of your upper and lower lips. That is where the two flaps of the mitral valve meet (the commissures). Now imagine that someone is holding the corners of your lips with two fingers. Can you open your mouth properly? No, you can't? That is what happens when the mitral valve is blocked. A 'commissurotomy' is a surgical procedure that frees those two corners.

How do you prepare before surgery?

Since this is a major surgery, preparation begins weeks in advance. Your medical team (cardiologist, cardiac surgeon) will perform a thorough examination of you.

• A complete physical examination
• Blood tests
• Talking at length about your symptoms and medical history

You will also be tested to see if there are any blockages in your mitral valve and other arteries in your heart, such as:

• Echocardiography - This is a scan of the heart.
• CT scans
• Coronary Angiography

How is the surgery done?

This is open-heart surgery. Here's the sequence of events that occur in the operating room:

1. You will be given anesthesia to put you completely to sleep.

2. An incision is made down the middle of the chest bone (sternum).

3. You will be connected to a cardiopulmonary bypass machine . This is to provide your body with the blood and oxygen it needs while your heart is stopped during surgery.

4. The surgeon opens the left atrium of the heart and examines the mitral valve.

5. Small incisions are made in the commissures of the valve to free them.

6. Then you will be removed from the heart-lung machine and your heart will be restarted.

7. Finally, a transesophageal echocardiogram is performed to confirm that the valve is working properly.

What happens after the surgery?

After the surgery, you will need to stay in the hospital for about a week. For the first day or two, you will be kept in the intensive care unit (ICU) and monitored very closely.

Before you leave the hospital, your doctor will advise you on the following:

• Cardiac Rehab: This is very helpful in regaining strength and getting used to normal life after surgery.
• How to care for the incision: This is very important to prevent infection and heal the wound quickly.
• About when you can start driving and working again .

Results, risks, and when to see a doctor

Open mitral commissurotomy has a very high success rate. It improves blood flow and greatly reduces symptoms. However, it is not a permanent solution. Many people who have this procedure may need valve replacement surgery at some point in the future.

As with every surgery, there are some risks.

• Mitral Regurgitation
• Heavy bleeding
• Infections
• Heartbeat irregularities (Arrhythmia)
• Stroke

However, these risks are minimized in a major hospital with experienced surgeons. If you have medical conditions such as diabetes, kidney disease, or obesity, the risk may be slightly higher. Talk to your doctor about this.

If you experience these symptoms, tell your doctor immediately:

• Fever
• Redness, swelling, or pus near the incision
• Recurrent chest pain or pressure

If you experience symptoms of a sudden heart attack (severe chest pain, difficulty breathing) or symptoms of a stroke (slurred speech, drooping of one side of the face), call 1990 immediately and go to the hospital's Emergency Treatment Unit (ETU).