Do you ever feel short of breath, or notice a feeling of tightness in your chest when you exert yourself or climb a flight of stairs? Your doctor may have mentioned that you are experiencing an issue with one of your heart valves. When a heart valve becomes stiff and fails to open properly, we call this condition ‘stenosis.’ Today, we are going to walk you through a specialized procedure used to treat this condition. Because this is such an important topic for your health, let’s break everything down into simple terms.
Simply put, what is a Commissurotomy?
Let’s start with the basics. Your heart has four main chambers. Think of them as four rooms in a house. For blood to flow smoothly from one room to the next, the doors between them must open and close properly. We call these doors heart valves.
A ‘commissurotomy’ is a surgery specifically related to your Mitral Valve. This valve acts as the door between your heart’s left atrium (upper chamber) and the left ventricle (lower chamber). This door has two flaps.
Due to certain medical conditions, most notably Mitral Valve Stenosis, the flaps of this door may fail to open correctly, much like a jammed lock. When this happens, blood flow from the upper chamber to the lower chamber is restricted. This causes blood to back up, putting significant strain on your heart and lungs. Over time, if left untreated, this can lead to serious complications such as heart failure.
A ‘commissurotomy’ is a procedure where the surgeon carefully makes small incisions to separate the fused edges (commissures) of the valve, allowing it to open fully again. This restores proper blood flow through your heart.
Who actually needs this surgery?
This surgery is not for everyone. Your doctor may recommend this procedure for a few primary reasons:
- If you have not experienced successful results from other treatments (such as medication).
- If you are not a suitable candidate for 'Balloon Valvuloplasty,' a procedure where a balloon is used to widen the valve.
- If you require other heart surgeries, this procedure can be performed simultaneously.
However, the most important factor is that the success of this surgery depends on the underlying cause of your mitral valve obstruction. Let us look at the two primary causes.
| Cause of Mitral Valve Obstruction | Details and Suitability for 'Commissurotomy' |
|---|---|
| Rheumatic Heart Disease | Damage to heart valves caused by rheumatic fever during childhood. This damage often manifests years later, leading to 'fused commissures' (where the valve leaflets stick together). The 'commissurotomy' procedure is most successful for this condition. |
| Degenerative Mitral Stenosis | Wear and tear of the valve as you age. In this case, it is not just the leaflets sticking together, but damage to other parts of the valve as well. Therefore, commissurotomy is generally not suitable for these patients, and they may require alternative valve repair or a Mitral Valve Replacement. |
What does it mean for valve leaflets to stick together?
It is quite easy to understand. Imagine you are standing in front of a mirror and smiling with your lips closed. Look at the two corners where your upper and lower lips meet; that is similar to how the two flaps (leaflets) of your mitral valve join together at the 'commissures.' Now, imagine someone pressing the corners of your lips together with their fingers. Can you open your mouth properly? You can't, right? That is what happens when the mitral valve is obstructed. A 'commissurotomy' procedure aims to release those fused corners to allow the valve to function normally again.
How do you prepare for the surgery?
Because this is a major surgery, preparations begin weeks in advance. Your medical team (the cardiologist and cardiothoracic surgeon) will conduct a comprehensive evaluation, including:
- A complete physical examination
- Blood tests
- A detailed discussion regarding your symptoms and medical history
Furthermore, to check the state of your mitral valve and see if there are blockages in other heart vessels, the following tests are performed:
- Echocardiography: An ultrasound scan of your heart.
- CT scans
- Coronary Angiography
If you have any questions or feel anxious about the surgery, please discuss them with your doctor to put your mind at ease. If you are a smoker, it is mandatory to quit completely before the surgery, as this significantly reduces surgical risks.
What happens during the surgery?
This is an open-heart surgery. Here is the step-by-step process in the operating room:
1. You will be given anesthesia to put you into a deep sleep.
2. An incision is made along the center of your chest bone (sternum).
3. You will be connected to a cardiopulmonary bypass machine. While your heart is temporarily stopped during the surgery, this machine will handle your blood flow and oxygen supply.
4. The surgeon will open the left atrium of your heart to examine the mitral valve.
5. Small incisions are made to release the fused parts (commissures) of the valve.
6. Afterward, you are disconnected from the bypass machine, and your heart is restarted.
7. Finally, a transesophageal echocardiogram is performed to ensure the valve is functioning correctly.
What happens after the surgery?
Following the surgery, you will need to stay in the hospital for about a week. You will be closely monitored in the Intensive Care Unit (ICU) for the first day or two.
Before you are discharged, your doctor will provide instructions on:
- Cardiac Rehab: This will greatly assist you in regaining strength and returning to your normal daily routine.
- Wound care: How to look after your incision to prevent infection and promote healing.
- When you can resume activities, such as driving and returning to work.
Results, Risks, and When to See a Doctor
The success rate of an open mitral commissurotomy is very high. It significantly improves blood flow and reduces most symptoms. However, this is not always a permanent final solution. Many patients who undergo this procedure may require a valve replacement surgery at some point in the future.
As with any surgery, there are certain risks, including:
- Mitral regurgitation (leaking valve)
- Excessive bleeding
- Infection
- Arrhythmia (irregular heartbeat)
- Stroke
However, these risks are minimized when performed by experienced surgeons at a major hospital. If you have conditions like diabetes, kidney disease, or obesity, your risk profile may be slightly higher; please discuss this with your physician at Nirogi Lanka.
Seek medical attention immediately if you experience these symptoms:
- Fever
- Redness, swelling, or pus drainage around the incision site
- Recurrent chest pain or pressure
If you experience signs of a heart attack (severe chest pain, difficulty breathing) or symptoms of a stroke (slurred speech, facial drooping), call 911 immediately or proceed to your nearest emergency department.
Take-Home Message
- A 'commissurotomy' is an open-heart procedure designed to repair a narrowed mitral valve, allowing it to function properly again.
- This condition is most commonly caused by damage to heart valves due to rheumatic fever during childhood.
- While this is a highly successful procedure, please keep in mind that it is often a temporary solution, and you may require a valve replacement in the future.
- Engaging in cardiac rehabilitation programs is essential for your recovery after surgery.
- It is very important to speak with your Nirogi Lanka doctor to clarify any questions you have regarding your condition, the procedure, or the associated risks.
Heart surgery, mitral valve, mitral valve stenosis, commissurotomy, heart disease, surgery, rheumatic heart disease, open heart surgery
