Let's learn about the heart valve surgery (Surgical Mitral Commissurotomy) in simple terms.

Think of your heart as a water pump that works non-stop. Inside this pump, there are four small door-like parts that help blood flow in only one direction. In medical terms, we call these heart valves. If these doors don't open and close properly, it's a big problem, isn't it? Similarly, today we are talking about a special surgery that is performed when the mitral valve, one of the most important valves in our heart, does not open properly and becomes narrow.

What is commissurotomy?

Simply put, a commissurotomy is a surgical procedure that allows blood to flow through a valve in your heart. It is most commonly performed on the mitral valve . The mitral valve is located between the upper left chamber (left atrium) and the lower left chamber (left ventricle).

Imagine that this door is not opening properly and is stuck and narrowed. We call this condition mitral valve stenosis. What happens is that the path for blood to flow from the upper chamber to the lower chamber is blocked. This causes the blood to back up and put a lot of strain on the heart and lungs. Over time, this can even lead to serious conditions like heart failure.

This commissurotomy surgery is used as a treatment for early stages of mitral valve stenosis. But to be honest, it is done much less often these days. Because it is usually done as an open-heart surgery . It has some risks. Therefore, whenever possible, doctors try to resort to simpler, less risky methods. One of the main treatments currently available is balloon valvuloplasty . In this, a thin tube is inserted and something like a balloon is inflated inside the narrowed valve, widening it.

However, for some people, the balloon method cannot be performed due to the position of their heart or other reasons. In such cases, commissurotomy surgery is the best option.

Who really needs this surgery?

If you have mitral stenosis and any of the following apply, your doctor may recommend this surgery:

• If you have not been cured by other treatments.
• If you cannot undergo balloon valvuloplasty.

Additionally, if you have had other heart surgeries, this surgery can be performed at the same time.

But one thing is important to remember. Not everyone with mitral valve stenosis can undergo this surgery. It depends on the cause of your valve stenosis.

There are two main reasons:

1. Damage caused by Rheumatic Heart Disease: Rheumatic fever, which follows a throat infection in childhood, can damage the heart valves years later.

2. Degenerative Mitral Stenosis: Over time, the valve gradually weakens, becomes narrowed, and becomes covered with calcium deposits.

Commissurotomy surgery is especially helpful for people with rheumatic heart disease . In this condition, the two corners of the valve where the two leaflets meet, called the commissures , thicken and sometimes stick together.

In commissurotomy surgery, small incisions are made at the two corners of the valve and they are released. Then the valve starts to open properly again. However, in people who have worn out valves due to age, the commissures are usually not damaged. Instead, other parts of the valve need to be repaired. Therefore, this surgery is not suitable for them. They will have to undergo a different type of valve repair or a complete valve replacement (mitral valve replacement).

What happens before the surgery?

Preparations begin weeks, sometimes months, before the day of your surgery. Your medical team (your family doctor, cardiologist, and cardiac surgeon) will come together to give you a thorough medical examination.

If you have any questions, fears, or doubts about the surgery, talk to your doctor about them. Don't keep anything to yourself. It's very important to know everything and go into the surgery with a relaxed mind.

Your doctor will give you instructions on how to prepare for surgery, including when to stop eating and drinking before surgery, and any changes to your medications.

How is the surgery performed?

In the operating room, the medical team follows these steps:

1. First, you will be given anesthesia and will be put to sleep until the surgery is complete. You will not feel any pain.

2. Next, the surgeon makes an incision in the middle of your chest, down the breastbone (sternum). This is called a median sternotomy .

3. You will be connected to a cardiopulmonary bypass machine . This machine temporarily takes over the work of your heart and lungs during surgery. This allows the doctor to perform the surgery while you are still, without your heart beating.

4. The left atrium of the heart is opened and the mitral valve is examined.

5. Then, very fine incisions are made at the two corners (commissures) of the valve that have become stuck and thickened, separating them from each other and releasing them.

6. After the work is done, you will be disconnected from the heart-lung machine and your heart and lungs will be started working again.

7. Finally, a special scan called a transesophageal echocardiogram is performed to confirm that the valve is working properly and that everything is working well.

Sometimes, other heart surgeries, such as repairing other heart valves (aortic valve or tricuspid valve), may be performed at the same time as this surgery. If this is necessary, the medical team will explain this to you in advance.

What happens after the surgery?

You will need to stay in the hospital for about a week after the surgery. For the first day or two, you will be kept in the intensive care unit (ICU) and monitored very closely. This is to help detect any complications that may arise after the surgery as soon as possible.

Before you go home from the hospital, your doctor will give you information about:

• Cardiac Rehab: This is very beneficial for people recovering from heart surgery. It helps you regain your strength and start doing normal activities.
• How to care for the incision: It is very important to keep the incision clean to prevent infection and heal the wound quickly.
• Restrictions: Advice on how long to wait before you can resume activities such as driving or doing heavy work.

Before you go home, don't forget to arrange for someone to pick you up.

What are the benefits and risks of this surgery?

Advantages

This surgery can relieve symptoms such as shortness of breath and fatigue caused by narrowing of the mitral valve. It can also protect you from serious complications that may occur in the future. This is a very good treatment for people whose condition is not severe enough to completely replace the valve and who have not been successful with other treatments.

Risks or Complications

As with any surgery, there are risks. The most common complication is mitral valve regurgitation .

Many of these risks can be reduced by receiving treatment at a major hospital with facilities and experienced surgeons in heart surgery.

What is the outlook after the surgery?

Open commissurotomy has a very high success rate. This surgery usually corrects the narrowing of the valve and restores blood flow.

Your doctor can best tell you about your future health. Everyone recovers differently. Many factors affect this, including your age, overall health, and the extent of damage to your valve before surgery.

When do you need to see the doctor?

If you develop any signs of infection while you are recovering at home after surgery, call your doctor immediately.

• Chest pain, tightness, or discomfort.
• Fever.
• Redness or pus-like fluid draining from the incision site.

If you experience any of the following severe symptoms, immediately call your local emergency number or go to the nearest hospital Emergency Department (ETU):

• Symptoms of a heart attack (severe chest pain, difficulty breathing, vomiting, sweating).
• Symptoms of paralysis (difficulty speaking, drooping of one side of the face, loss of a limb).