Closed mitral valvotomy is one of the oldest modern heart surgeries having been around for decades. With the advent of open heart surgery and balloon mitral valvotomy, the number of closed mitral valvotomy performed in the Western nations is relatively small. However, the simplicity, technical ease, and lower cost make it a commonly performed mitral valve surgery in Eastern and developing nations. For example, closed mitral valvotomy is still routinely performed in India.
The mitral valve is the valve between the left atrium and the left ventricle. If it becomes narrowed or diseased, it can block the flow of blood from left atrium to left ventricle within the heart. This condition is called mitral valve stenosis and is rather common. If left untreated it can lead to an enlarged heart, poor blood circulation, and back up of fluid in the lungs. Mitral valve stenosis shortens life spans if it is not treated effectively.
There are several options when it comes to treating mitral valve stenosis. One of the more common approaches in the west is to perform open heart surgery. The blood is shunted through a heart lung bypass machine, the chest is opened at the rib cage, and the mitral valve is corrected surgically.
Alternatively, balloon mitral valvotomy uses a tube that is snaked through the arteries until it reached the left side of the heart. Once the end of the catheter is across the mitral valve, a balloon is inflated and the blockage is forcibly broken apart.
In a closed mitral valvotomy, a medium sized incision is made in the chest wall below the armpit. The incision is large enough for a surgeon to pass a finger and thin instruments through it. The surgeon then places a finger in the left atrium. The surgical instrument is then pushed through the outer wall of the heart muscle. A device called a Tubb’s dilator is placed across the mitral valve. Once the dilator is in place, as determined by the surgeon’s hand in the right atrium, it is opened, which breaks apart the blockage and relieves it.
The advantage of a closed mitral valvotomy is that the heart does not need to be opened so recovery from the procedure is much faster and less arduous than open mitral valvotomy. It requires less equipment and surgeons generally require less specialized equipment training to perform closed mitral valvotomy. That said, there is an amount of surgical skill required to successfully perform the procedure.
While a closed mitral valvotomy is simple and can be performed without a modern surgical suite and equipment, there are some disadvantages to the procedure. If the Tubb’s dilator opens the mitral valve too much, the valve is no longer stenotic, but rather it becomes leaky. A leaky mitral valve is termed mitral regurgitation and means that blood flows in the wrong direction through the left ventricle and left atrium. If this occurs, the closed mitral valvotomy may need to be converted to an open heart surgery with mitral valve repair or replacement.