Successful Minimally Invasive Mitral Valve Replacement

Background

Mrs. Anju Datta, a 70-year-old woman, was admitted to BM Birla Heart Hospital under the care of Dr. Debabrata Biswas, Senior Cardio-Thoracic Surgeon, with complaints of acute shortness of breath, worsened by walking and relieved by lying down, along with chest discomfort persisting for two weeks. A known case of Rheumatic Heart Disease (RHD) with severe Mitral Stenosis (MS), she also had a history of Type 2 Diabetes Mellitus (T2DM), hypothyroidism, and multiple past medical interventions, including a pacemaker (PPM) in 2024, hip replacement (2022), and breast tumor surgery (2016). In February 2024, she was hospitalised for pneumonia and pleural effusion, requiring pleural tapping.

Investigation & Analysis

A detailed echocardiography revealed:

• Thickened, calcified mitral valve with reduced pliability
• Moderate sub-valvular fusion
• Severe mitral stenosis with an orifice area of 0.85 sq. cm
• Mitral regurgitation (Grade II) and aortic regurgitation (Grade I)
• Pulmonary artery systolic pressure (PASP) of 80 mmHg
• Normal left ventricular function (EF 60%)

A carotid Doppler showed 25% luminal stenosis on the right side, while a coronary angiogram confirmed normal coronary arteries. Given her deteriorating condition, Dr. Debabrata Biswas and his team recommended Minimally Invasive Cardiac Surgery (MICS) for Mitral Valve Replacement using a 25mm Mitral Pericarbon More Bio-Prosthesis tissue valve.

Treatment & Management

Surgical Procedure:

• A MICS Mitral Valve Replacement was performed with a cross-clamp time of 66 minutes.
• The patient was successfully weaned off bypass on the first attempt with selective inotropic support.

Post-Operative Care

• Extubated after 36 hours.
• Shifted to the general ward on post-operative day 4.
• Post-operative echocardiography showed improved mitral valve function with a pressure gradient of 12/6 mmHg and PASP reduced to 70 mmHg.

Mrs. Datta was discharged in stable condition without any complications.

Dr. Debabrata Biswas, renowned doctor for Mitral Valve Replacement in Kolkata, said “Minimally invasive mitral valve replacement offers better recovery and reduced surgical trauma, especially in elderly patients. Mrs. Datta’s successful surgery reflects our commitment to delivering advanced cardiac care at BM Birla Heart Hospital.”

BM Birla Heart Hospital remains dedicated to pioneering innovative treatments and enhancing patient outcomes in complex cardiac cases.