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TRANSLATION

If you would like this information in another language or format, please contact the Service Equality Manager on 0116 258 4382.

Haddaad rabto warqadan oo turjuman oo ku duuban cajalad

ama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta 0116 258 4382.

Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını isterseniz lütfen servis müdürüne 0116 258 4382 telefonundan ulaşabilirsiniz.

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INTRODUCTION

The aim of this booklet is to provide you with information about mitral valvuloplasty so that you are better prepared for the procedure.

WHAT IS MITRAL STENOSIS?

Mitral stenosis is a heart condition where the mitral valve on the left side of the heart narrows and thickens causing obstruction of blood flow through the heart.

WHAT IS MITRAL VALVULOPLASTY?

Mitral Valvuloplasty involves stretching the mitral valve with a balloon, which is threaded into the heart through the vein (femoral) in the groin.

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HOW DO I NEED TO PREPARE MYSELF?

If you are taking Warfarin this needs to be stopped for 3 days before your procedure. You should shower or bath on the morning of the procedure. You will be informed when to stop eating and drinking; this is usually 4 hours prior to the procedure taking place.

It is important that you shave your hair to both sides of your groin areas, as this is where the tube is passed into the femoral vein at the top of your leg. If you are concerned about doing this, the nurse will be able to help you.

THE PROCEDURE

Mitral Valvuloplasty is sometimes performed under local anaesthetic, at other times under general anaesthetic. If a general anaesthetic is used this allows a transoesophageal probe to be passed into the gullet so that the mitral valve can be assessed during the procedure. If local anaesthetic is used, assessment of the mitral valve is made by an echo test from the chest wall.

When you arrive in the catheter room you will notice that there is a lot of machinery. Although this can be quite overwhelming, don’t be alarmed. This is specialist monitoring and x-ray equipment and will not harm you in any way.

You will be required to lie on a hard x-ray table and heart monitor wires will be attached to your arms and legs.

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The valvuloplasty catheter is relatively large and bleeding into the puncture site from the groin where the catheter is introduced may occur. Sometimes in about 5% of patients there may be significant bruising and damage to the groin vessels and a surgeon may need to repair these.

Withdrawal of the balloon used to dilate the valve across the atrial septum may sometimes lead to a large as opposed to a very small hole present in the atrial septum. A hole in the heart (atrial septal defect) may then be produced and in rare occasions may need later surgical closure.

The procedure involves using x-ray equipment therefore the amount of radiation you are exposed to is monitored carefully especially as the procedure can last several hours. The radiation risk and the x-rays used is equivalent to 4.2 years background radiation (radiation that is normally found in the atmosphere which is present in everyday life).

If you have any specific worries about any of these issues, please discuss them with your consultant.

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If you develop any problems at home or need some medical advice, do not hesitate to contact the ward. You may be able to speak to one of the doctors or nurses who looked after you.

A follow-up appointment is not always necessary. If we do need to see you again in outpatients you will be informed by letter.

IS THERE ANY RISK?

Any operation carries a risk to life and to limb and the mortality risk in Mitral Valvuloplasty is 0.5% i.e. 1 in 200 patients.

The main risk of stretching a mitral valve is for the valve to become severely leaky. A mild increase in the amount of leak (regurgitation) is quite common with the procedure. However, in about 5% of patients the valve becomes significantly leaky and will require replacement within 6 months. In about 2% of patients this is necessary as an emergency during the valvuloplasty procedure.

It is necessary to puncture the wall between the two receiving chambers (the atrial septum between the right atrium and the left atrium to gain access to the mitral valve). There is a risk that sometimes a needle puncture may not end up in the correct place and the wall of the heart be punctured and bleeding occurs into the heart sack. This might require emergency surgery. The total risk of emergency surgery is approximately 2% (1 in 50 patients).

Most patients with Mitral Stenosis have an irregular heart rhythm known as atrial fibrillation however, some patients still are in normal rhythm (sinus rhythm) and this procedure may lead to atrial fibrillation. This is not usually serious.

As with open heart valve surgery there is a small risk of 1-2% of stroke.

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To begin the procedure, the doctor will clean your left and right groin areas with a cold antiseptic liquid. He will then cover you with green cloths to maintain a sterile working area. You will then be injected with local anaesthetic in both groins to freeze the area where the tubes will be inserted into the blood vessels (one in either side).

Through the tubes, the doctor will pass catheters up into the heart to measure the pressures in the heart.

During the procedure you may have injections of x-ray dye into the heart which will make you experience hot flushes.

These will last for only a few seconds and are not painful.

Shortly, following these, one of the tubes in your groin will be exchanged for a slightly bigger tube. Some more local anaesthetic may be injected into the site to reduce any discomfort. The bigger tube is a special catheter, which is passed up into the heart and serves to make a small opening from one side of the heart to the other. At this point you will be given an anti-clotting drug through the needle in your hand/arm. The way is now clear for a balloon mounted on a catheter to be passed up into the heart valve where it is blown up and let down again. This may be repeated a few times. At this point you may feel dizzy; this is quite normal.

Once the balloon has been let down and pulled out, you may have another x-ray dye injection.

The procedure takes 2-3 hours and you will have a nurse to support and reassure you for this duration.

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You will have a tube in each groin called a sheath, whilst in place you need to stay on bed rest. It is also important to keep your leg straight so that bruising is kept to a minimum. They will be removed either in the ward or in the catheter room suite.

ON RETURN TO THE WARD

Your nurse will collect you from the catheter suite where a brief handover is given about you.

On return to the ward, the nurse will check your blood pressure, pulse and pulses in your feet (called ‘pedal pulses’). An ECG 4 (Electrocardiograph or heart tracing) will also be performed. These are all routine checks that are required in case any complications develop.

You will also be connected to a drip - or IVI (intravenous infusion), that will be running for approximately 4-6 hours.

SHEATH REMOVAL

After approximately 2 hours if your sheaths are still in, a sample of blood will be taken to see if your blood clotting time is back to normal. Then your sheath can be removed. When the sheaths are being removed, a nurse or doctor will press quite hard for at least 10-20 minutes. You will be connected to a cardiac monitor so that the staff can ‘keep an eye’ on your heart rate.

Once the sheaths are removed, you will have to place your hand on your sheath site - using a piece of gauze for at least 20 minutes. If you need to cough, laugh, sneeze etc., please make sure you press on the gauze.

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You will now be advised to stay on bedrest for 2-4 hours. It is important to check your ‘sheath site’ on a regular basis in case any bleeding or oozing develops. If any bleeding occurs let the nurse know. The plaster can stay in place for two days then it can be removed, as exposure to the air enables the wound to heal.

BEFORE DISCHARGE

On the evening of the procedure your usual dose of Warfarin should be restarted.

Sometimes a repeat echocardiogram will be requested. An echocardiogram is a scan of your heart using ultrasound equipment. This will occur the following day.

DISCHARGE

If there are no complications you will be able to go home the day after your procedure. The doctors will speak to you about your results.

You should do as little as possible for two days this means,

·  NO HEAVY LIFTING

·  NO CLEANING

·  NO SHOPPING

·  NO GARDENING

You are advised not to drive for two days. You do NOT need to contact the DVLA unless you hold a PSV/HGV licence

It is common to experience some bruising to your groin area - however, if a painful large lump appears, seek medical advice.

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This booklet has been written by:

Nikki Gardiner, RGN, Ward 32

and

Giselle Broomes-Pakeerah, RGN

with helpful advice from:

Dr. Peter Hubner, Consultant Cardiologist.

Booklet design by:

Kay Pratt

Cardiac Services Secretary

All Rights Reserved

NG/GB-P/SHM/KAP

March 1998

Updated April 2007

University Hospitals of Leicester NHS Trust

Glenfield Hospital

Groby Road

Leicester

LE3 9QP

Telephone: 0300 303 1573

Fax: 0116 2583950

Minicom: 0116 2879852

CARDIAC SERVICES

MITRAL VALVULOPLASTY

A PATIENT GUIDE

University Hospitals of Leicester

NHS Trust

Glenfield Hospital