Some people with RHD will need heart surgery. Finding out that that you need a heart operation is frightening for most people. It can also be a worrying and stressful time because heart surgery for children and adults is not possible in every part of the world. The process for accessing heart surgery is very different in different places – you will need to discuss surgical options with your doctor and specialist.
There are different kinds of heart surgery for RHD:
Balloon valvotomy / commissurotomy
In some places balloon valvotomy can be used to treat mitral stenosis. This operation can be done by threading a deflated balloon on wires up to the heart from a cut in the groin. The narrowed mitral valve is opened by gently inflating a balloon inside the valve. The procedure may need to be repeated some years later. Balloon valvotomy requires only a small cut in the groin, this reduces costs and complications compared with open surgical repair, providing a safe and effective option for low resource settings. However, a cardiac catheterization laboratory is required to perform the procedure and few facilities exist in the areas of greatest need.
Mitral valve repair is an open heart surgical procedure, which means surgeons need to open up the chest and operate directly on the hear. Surgeons repair the shape and function of damaged valve leaflets allowing for more normal blood flow. Repair offers the best outcomes for children and adults with RHD. However, valve repair is technically more difficult than valve replacement and can only be performed by surgeons specialized in valve repair technique.
Heart valve replacement is an open heart surgical procedure. Surgeons remove the damaged heart valve and replace it with a mechanical prosthetic (metallic valve) or bioprosthetic valve (tissue valve). Bioprosthetic valve replacements cause fewer blood clot complications than metal valves but are more likely to wear out and require replacement. Mechanical valve replacement is associated with high risk of embolism and haemorrhagic complications but usually last for life.
It is normal to have lots of questions about what to expect before, during and after your operation. You may be able to meet your heart surgeon before the operation to ask some of these questions. Other information can be found online, including excellent resources for parents of children undergoing heart surgery. Developed by Children’s Heart Link the parent education / discharge instruction (PEDI) resources provide information on preparing for admission and for caring for children at home. Booklets are available in 12 languages online.