Mitral Valve Open Commissurotomy

WHAT YOU SHOULD KNOW:

Mitral Valve Open Commissurotomy (Inpatient Care) Care Guide

Mitral valve open commissurotomy is surgery to repair the mitral valve in your heart. You may need this valve fixed if you have mitral valve stenosis. This is when your mitral valve becomes narrow and cannot open all the way. The mitral valve normally opens and closes to let blood pass through the heart. If your mitral valve does not open or close correctly, blood may not flow as it should through your heart.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • You may bleed, get an infection, or have trouble breathing during or after surgery. Air bubbles in your blood could cause a stroke. The muscles or other valves in the heart could be damaged. You may have problems with your heartbeat or have a heart attack. Your kidneys may stop working and you may need dialysis. You may get a blood clot in your arm or leg. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke.

  • Without surgery, your symptoms, such as shortness of breath and fatigue could get worse. Blood and fluid could build up in your lungs and lead to heart failure.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

  • CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

  • You may be given medicine in your IV to help you relax or make you drowsy. You will get general anesthesia to keep you completely asleep. A caregiver will clean your chest with soap and water. The soap may make your skin yellow, but it will be cleaned off later. An incision will be in the middle of your chest.

  • You will be connected to a heart-lung bypass machine. This machine does the work of your heart and lungs during surgery. The valve leaflets are separated and the opening in the valve may be dilated (made larger). Then the heart is checked to make sure there is no bleeding.

  • Caregivers may put wires your chest that stay in for a short time after surgery. The wires can be used to improve your heartbeat. The bypass machine will be removed, and your own heart and lungs will start working again. A transesophageal echocardiogram (TEE) will be done to see how well the valve and your heart are working. The incision in your chest will be closed with stitches or staples and covered with a bandage. The bandage keeps the area clean and dry to help prevent infection.

After surgery:

You will be taken to the recovery room or an intensive care unit (ICU). Caregivers will watch you very closely. A caregiver may remove the bandage shortly after surgery to check the incision. Do not get out of bed until your caregiver says it is okay.

  • Blood gases: Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.

  • Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.

  • Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.

    • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.

    • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

  • Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

  • Eating after surgery: You may be given ice chips and liquids such as water, broth, juice, and clear soft drinks after surgery. If your stomach does not become upset, you may then be given soft foods. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Activity: Move your legs, ankles, and feet as directed while you are in bed. You may be asked to stand the same day of your surgery. You may start to walk the day after your surgery. If you ever feel weak or dizzy, sit or lie down right away.

  • Medicines:

    • Blood pressure medicine: This is given to lower your blood pressure.

    • Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise.

    • Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.

    • Heart medicine: This medicine is given to strengthen or regulate your heartbeat.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine.

    • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

    • Antibiotics: This medicine may be given to help prevent or treat infection caused by bacteria.

  • Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.

  • Oxygen and a ventilator: You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).

  • Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

  • Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots.

  • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots.

  • Temporary pacemaker: This is a machine that helps your heart beat at a normal speed and in a regular rhythm. You may need this for a short time after surgery.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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