Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- Part II Surgical procedures and their complications
- 42 Tracheostomy
- 43 Thyroidectomy
- 44 Parathyroidectomy
- 45 Lumpectomy and mastectomy
- 46 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- 47 Small bowel resection
- 48 Appendectomy
- 49 Colon resection
- 50 Abdominoperineal resection
- 51 Anal operations
- 52 Cholecystectomy
- 53 Common bile duct exploration
- 54 Major hepatic resection
- 55 Splenectomy
- 56 Pancreatoduodenal resection
- 57 Adrenal surgery
- 58 Lysis of adhesions
- 59 Ventral hernia repair
- 60 Inguinal hernia repair
- 61 Laparotomy in patients with human immunodeficiency virus infection
- 62 Abdominal trauma
- 63 Coronary artery bypass procedures
- 64 Cardiac rhythm management
- 65 Aortic valve surgery
- 66 Mitral valve surgery
- 67 Ventricular assist devices and cardiac transplantation
- 68 Pericardiectomy
- 69 Pulmonary lobectomy
- 70 Pneumonectomy
- 71 Hiatal hernia repair
- 72 Esophagogastrectomy
- 73 Colon interposition for esophageal bypass
- 74 Carotid endarterectomy
- 75 Abdominal aortic aneurysm repair
- 76 Aortobifemoral bypass grafting
- 77 Femoropopliteal bypass grafting
- 78 Lower extremity embolectomy
- 79 Treatment of chronic mesenteric ischemia
- 80 Inferior vena cava filters
- 81 Portal shunting procedures
- 82 Breast reconstruction after mastectomy
- 83 Facial rejuvenation
- 84 Liposuction
- 85 Repair of facial fractures
- 86 Flap coverage for pressure sores
- 87 Muscle flap coverage of sternal wound infections
- 88 Skin grafting for burns
- 89 Abdominal hysterectomy
- 90 Vaginal hysterectomy
- 91 Uterine curettage
- 92 Radical hysterectomy
- 93 Vulvectomy
- 94 Craniotomy for brain tumor
- 95 Intracranial aneurysm surgery
- 96 Evacuation of subdural hematomas
- 97 Stereotactic procedures
- 98 Transsphenoidal surgery
- 99 Treatment of herniated disk
- 100 General considerations in ophthalmic surgery
- 101 Cataract surgery
- 102 Corneal transplantation
- 103 Vitreoretinal surgery
- 104 Glaucoma surgery
- 105 Refractive surgery
- 106 Eye muscle surgery
- 107 Enucleation, evisceration and exenteration
- 108 Arthroscopic knee surgery
- 109 Total knee replacement
- 110 Total hip replacement
- 111 Fractures of the femoral shaft
- 112 Surgery for hip fractures
- 113 Lumbar spine surgery
- 114 Surgery for scoliosis or kyphosis in adults
- 115 Surgery of the foot and ankle
- 116 Lower extremity amputations
- 117 Surgical procedures for rheumatoid arthritis
- 118 Otologic surgery
- 119 Myringotomy and tubes
- 120 Tonsillectomy and adenoidectomy
- 121 Uvulopalatopharyngoplasty
- 122 Endoscopic sinus surgery
- 123 Cleft palate surgery
- 124 Facial surgery
- 125 Tracheotomy
- 126 Surgical management of head and neck cancer
- 127 Anterior cranial base surgery
- 128 Surgery for syndromic craniosynostosis
- 129 Nephrectomy
- 130 Cystectomy and urinary diversion
- 131 Radical prostatectomy
- 132 Transurethral resection of the prostate (TURP)
- 133 Interstitial laser thermal therapy for benign prostatic hyperplasia
- 134 Management of upper urinary tract calculi
- 135 Female urinary incontinence surgery
- Index
- References
66 - Mitral valve surgery
Published online by Cambridge University Press: 12 January 2010
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- Part II Surgical procedures and their complications
- 42 Tracheostomy
- 43 Thyroidectomy
- 44 Parathyroidectomy
- 45 Lumpectomy and mastectomy
- 46 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- 47 Small bowel resection
- 48 Appendectomy
- 49 Colon resection
- 50 Abdominoperineal resection
- 51 Anal operations
- 52 Cholecystectomy
- 53 Common bile duct exploration
- 54 Major hepatic resection
- 55 Splenectomy
- 56 Pancreatoduodenal resection
- 57 Adrenal surgery
- 58 Lysis of adhesions
- 59 Ventral hernia repair
- 60 Inguinal hernia repair
- 61 Laparotomy in patients with human immunodeficiency virus infection
- 62 Abdominal trauma
- 63 Coronary artery bypass procedures
- 64 Cardiac rhythm management
- 65 Aortic valve surgery
- 66 Mitral valve surgery
- 67 Ventricular assist devices and cardiac transplantation
- 68 Pericardiectomy
- 69 Pulmonary lobectomy
- 70 Pneumonectomy
- 71 Hiatal hernia repair
- 72 Esophagogastrectomy
- 73 Colon interposition for esophageal bypass
- 74 Carotid endarterectomy
- 75 Abdominal aortic aneurysm repair
- 76 Aortobifemoral bypass grafting
- 77 Femoropopliteal bypass grafting
- 78 Lower extremity embolectomy
- 79 Treatment of chronic mesenteric ischemia
- 80 Inferior vena cava filters
- 81 Portal shunting procedures
- 82 Breast reconstruction after mastectomy
- 83 Facial rejuvenation
- 84 Liposuction
- 85 Repair of facial fractures
- 86 Flap coverage for pressure sores
- 87 Muscle flap coverage of sternal wound infections
- 88 Skin grafting for burns
- 89 Abdominal hysterectomy
- 90 Vaginal hysterectomy
- 91 Uterine curettage
- 92 Radical hysterectomy
- 93 Vulvectomy
- 94 Craniotomy for brain tumor
- 95 Intracranial aneurysm surgery
- 96 Evacuation of subdural hematomas
- 97 Stereotactic procedures
- 98 Transsphenoidal surgery
- 99 Treatment of herniated disk
- 100 General considerations in ophthalmic surgery
- 101 Cataract surgery
- 102 Corneal transplantation
- 103 Vitreoretinal surgery
- 104 Glaucoma surgery
- 105 Refractive surgery
- 106 Eye muscle surgery
- 107 Enucleation, evisceration and exenteration
- 108 Arthroscopic knee surgery
- 109 Total knee replacement
- 110 Total hip replacement
- 111 Fractures of the femoral shaft
- 112 Surgery for hip fractures
- 113 Lumbar spine surgery
- 114 Surgery for scoliosis or kyphosis in adults
- 115 Surgery of the foot and ankle
- 116 Lower extremity amputations
- 117 Surgical procedures for rheumatoid arthritis
- 118 Otologic surgery
- 119 Myringotomy and tubes
- 120 Tonsillectomy and adenoidectomy
- 121 Uvulopalatopharyngoplasty
- 122 Endoscopic sinus surgery
- 123 Cleft palate surgery
- 124 Facial surgery
- 125 Tracheotomy
- 126 Surgical management of head and neck cancer
- 127 Anterior cranial base surgery
- 128 Surgery for syndromic craniosynostosis
- 129 Nephrectomy
- 130 Cystectomy and urinary diversion
- 131 Radical prostatectomy
- 132 Transurethral resection of the prostate (TURP)
- 133 Interstitial laser thermal therapy for benign prostatic hyperplasia
- 134 Management of upper urinary tract calculi
- 135 Female urinary incontinence surgery
- Index
- References
Summary
Both in the USA and worldwide, the most common cause of mitral valve pathology in adults is rheumatic fever (RF). Postrheumatic structural changes to the mitral valve typically occur over the 2 to 10 years following infection, with symptoms appearing over the subsequent 5 to 10 years. In descending order, secondary etiologies include myxomatous degeneration, endocarditis, idiopathic annular calcification, connective tissue disorders (Marfan's and Ehlers–Danlos disease), and hypertrophic cardiomyopathy; however, mitral stenosis (MS) is almost exclusively attributable to rheumatic fever. The advent of decompensated heart failure in MS patients is typically presaged by decreased exercise tolerance with progressive dyspnea secondary to low cardiac output, pulmonary hypertension, and decreased lung compliance. Timely operative intervention early in the symptomatic period can completely reverse heart failure. Mitral regurgitation (MR), where the valve is almost purely regurgitant, is also caused by RF. Ischemic MR is present in up to 20% of patients with coronary artery disease (CAD) requiring operative coronary artery bypass (CAB), and infrequently involves the catastrophic event of ruptured papillary muscle.
Indications for operation depend upon the pathophysiologic condition present. In severe MS, symptoms and signs of worsening heart failure absolutely indicate surgery. Angiographic or echocardiographic estimation of a mitral orifice area of 2 cm2 denotes mild to moderate disease, while 1 cm2 denotes severe levels. Intervention should be undertaken prior to the appearance of heart failure, which significantly worsens outcome.
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- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 585 - 588Publisher: Cambridge University PressPrint publication year: 2006