MITRAL VALVE REPLACEMENT – REVIEW AND CASE STUDY

Ms. Shivani Shyamkumar Shrivastava

Final year MSc Nursing, Kasturba Nursing College, Sewagram

INTRODUCTION ARTERIAL BLOOD GAS INVESTIGATION REPORT MANAGEMENT

ANALYSIS REPORT Investigations Values
Mitral regurgitation affects 80% of people, and echocardiography Medical management:
Investigations Values Biochemistry  Inj. Ceftraixone 2gm IV BD
can show some normal valve leakage in these people. Mild
regurgitation seldom causes overt clinical illness and is well pH 7.41 Serum LDH 1145  Inj. Vancomycin 500 mg IV TDS
tolerated. When being severe, blood is pulled both backward over pCO2 43.1 Troponin T 0..7  Inj. Furosemide 40 mg IV BD
the mitral valve and forward into the systemic circulation, pO2 76 Ferritin 22.78  Inj. Paracetamol 500 mg TDS
overloading the left ventricle which eventually leads to ventricular HCT 36%  Tab. Clopidogrel + Aspirin (75+75mg)
Liver panel
enlargement and contractile failure over time. These physiological HCO3 26.2 OD
Protein 6.78
alterations result in shortened survival and signs of heart failure if  Tab. Atorvastatin 40 mg HS
Na 133 Albumin 3.17
left untreated.¹ Surgical management:
K 3.80 Bilirubin (C) 1.90  Mitral valve replacement with 27mm
BACKGROUND Ca 0.96 Bilirubin (T) 4.32 TTK CHITRA mechanical mitral valve
Cl 92 ALT 551  Midline sternotomy done
Heart valve diseases are a major cause of cardiovascular morbidity  Pericardium opened and hitched and
and death globally. Nearly all cases of mitral stenosis, which are Anion gap 14.2 AST 842
SO2 95.1 heparinised
more common in females, have rheumatic causes (97.4%). Alk Phosphatase 223
 Complete support of Cardiopulmonary
Rheumatic mitral regurgitation is the most common kind (41.1%), Haematology
Bypass
closely followed by myxomatous or mitral valve prolapse (40.8%). Hb 10.4  Replacement done and protaminised
Therefore, the burden of valvular heart disease is mostly caused by RBC 4.59  Haemostasis achieved
diseases like rheumatic heart disease.²  Retrocardiac and retrosternal drains
WBC 8.1
PLT 193 attached.
PURPOSE PCV 34.9
MCV 76.1
The purpose of this case study and review was to investigate the
early detection and comprehensive treatment plan of care for Mitral RDW-cv 19.2
Regurgitation. LY% 21.6
Mixed% 8.2
Mitral valve replacement using
GR% 70.2
CASE DESCRIPTION mechanical valve
Devices used for mitral valve replacement

 A 35 year old female, diagnosed as a case of severe Mitral
valve regurgitation and mitral valve stenosis.
 Admitted with chief complaints of:
• Anorexia since 4 days
• Constipation since 5 days
• Bilateral limb and periorbital swelling since 4 days
 Past medical history – Mitral regurgitation and stenosis and
pulmonary hypertension
 Past surgical history – None
 Obtretical history – one normal vaginal delivery
 Personal history – Consumes mixed diet having normal bowel
and bladder pattern.
DISCUSSION AND CONCLUSION
 Health education and counselling prior to the procedure is a key towards gaining co-operation from client and
also helps in reducing anxiety of client and his/her family.
 Contemporary recommendations restrict the use of surgical mitral valve replacement to pathologies when
lasting repair is unlikely to be achieved, and several worldwide databases reflect a considerable decline in
replacement procedures done compared to repairs.³
 Mitral valve replacement has decreased hospital length of stay and increased 10-year survival. In the current
dataset, patients who are older than 60 or who require concurrent CABG do not significantly benefit from
mitral valve repair versus replacement in terms of long-term survival.⁴
REFERENCES

1. Otto CM, Verrier ED. Mitral regurgitation — what is best for my patient? New England Journal of Medicine.
ELECTROCARDIOGRAPHY MITRAL VALVE 2011;364(15):1462–3. doi:10.1056/nejme1102013
REPORT REGURGITATION 2. http://dx.doi.org/10.1016/j.ihj.2014.03.010
3. van der Merwe J, Casselman F. Mitral Valve Replacement-Current and Future Perspectives. Open J Cardiovasc Surg. 2017
Jul 13;9:1179065217719023. doi: 10.1177/1179065217719023. PMID: 28757798; PMCID: PMC5513524.
4. https://doi.org/10.1161/01.CIR.0000079169.15862.13
5. https://www.google.com/url?sa=i&url=https%3A%2F%2Fhealthjade.net%2Fmitral-valve-regurgitation%2F&psig=AOvVaw
0L4jOA2o3HlHsjF0mpsZBz&ust=1692896986618000&source=images&cd=vfe&opi=89978449&ved=0CBAQjRxqFwoTC
LCBv--i84ADFQAAAAAdAAAAABAE
6. https://www.google.com/url?sa=i&url=https%3A%2F%2Fmyheart.net%2Farticles%2Fmitral-valve-replacement-surgery%2F
&psig=AOvVaw3KWGxfM9p0Pvxy967Oaukk&ust=1692891343763000&source=images&cd=vfe&opi=89978449&ved=0
CBAQjRxqFwoTCICj_O6N84ADFQAAAAAdAAAAABAE
ACKNOWLEDGEMENT
The investigator acknowledges Ms. Snehal Jambhulkar, Ms. Priyanka Jagtap, Ms. Deepa Karmankar
and Mr. Dipak Sawarkar for their esteemed help along with the patient for her willingness to
participate in collecting data for the case study.