The document discusses mitral valve replacement surgery. It defines mitral valve replacement as replacing a diseased mitral valve with a mechanical or tissue valve. Common causes of mitral valve disease include rheumatic fever, infections, and inherited conditions. The document outlines the types of artificial valves used, selection criteria for the procedure, and the roles and responsibilities of nurses in pre-operative, intra-operative, and post-operative care of patients undergoing mitral valve replacement surgery.

2. DEFINITION
‘Mitral valve replacement is a
procedure whereby the diseased
mitral valve of a patients heart is
replaced by either a mechanical or
tissue(bioprosthetic )valve.’

3. INDICATIONS
• Mitral valve regurgitation
• Mitral valve stenosis
Causes of mitral valve disease:-
 Infection
Calcification
Inherited collagen disease

4. Cont..
MITRAL STENOSIS
• Rheumatic fever
• Mitral degenerative disease
• Severe calcification
• Congenital deformities
• Malignant carcinoid
syndrome
• Neoplasm
• Left atrial appendage
thrombus
• Endocarditic vegetations
• Inherited metabolic
diseases
• Complication of previos
procedures
MITRAL REGURGITATION
• Myxomatous degeneration
(barlow disease)
• Ischemic heart disease
• Dilated cardiomyopathy
• Rheumatic valve disease
• Mitral annular calcification
• Infective endocarditis
• Congenital anomalies
• Endocardial fibrosis
• Myocarditis
• Collagen- vascular
disorders.

5. ANATOMY AND PHYSIOLOGY

8. ARTIFICIAL VALVE TYPES
TWO TYPES
Mechanical
valves
Bioprosthetic
valves
•Caged ball valve
•Tilting disc
•Bileaflet disc

10. SELECTION CRITERIA
• Risk benefit ratio
• Multifactorial :-
Age
Site of involvement
Size of LV cavity
Special situation
Patients preference

11. PROCEDURE

12. NURSING RESPONSIBILITY
PRE-OPERATIVE
INTRA-
OPERATIVE
POST-OPERATIVE

13. ASSESSMENT
• Pulse- weak, irregular
• Increase intensity of s1
• diastolic rumble / diastolic murmur
• Atrial dysrhythmias

14. Nurses role for heart valve replacement
• Enquire whether patient is pregnant.
• For one week period before surgery the patient may be asked to
stop taking medications that make it harder for patients blood to
clot eg:- aspirin
• Conform with the physician/surgeon which drug patient has to
still take on the day of surgery.
• Prophylactic antibiotics may be initiated before surgery
• Periodic monitoring of all vital signs are necessary after surgery.
• Special care for the patients who may already have chronic
arrhythmias, altered left ventricular function, and pulmonary
hypertension.
• Great care is required with fluid management and haemodynamic
monitoring .
• Hospital acquired infections plays a greater role in infective
endocarditis, good infection control practices should follow.

15. Main focus
• Hemodynamic stability
• Recovery from anaesthesia
• Frequent assessment with attentions to
neurologic, respiratory , and cardiovascular
systems

16. COMPLICATIONS
complications depends on :- patients age , general
health, specific medical condition, and heart
functions.
• Bleeding
• Infection
• Thromboembolism
• Renal shutdown
• Cardiac tamponade
• Stroke
• Death 1%

17. Patient education
• Anticoagulant therapy
• Prevention of infective endocarditis.
• Follow up
• Repeat endocardiograms.

20. PRE-OPERATIVE
• Psychological preparation
• Eradicate fear of operation from the patient
• Meet the spiritual needs of the patient
• Obtain informed consent
• Build up the general health of the patient and correction of the
disease process for speedy recovery.
• Pre-operative teaching
• Surgical preparation of the skin
• Preparation of the patient on the evening before operation
• Preparation of the patient on the day of surgery
• Sending the patient to operating room

21. Nursing diagnosis of the pre-operative
client
• Anxiety related to lack of knowledge about pre-operative
routines and post-operative care.
• Fear related to effect of surgery and ability to function in usual
roles .
• Fear related to the risk of death
• Anxiety related to the outcome of surgery.
• Fear related to loss of control during anaesthesia or waking up
during anaesthesia.
• Sleep pattern disturbances related to hospital routines and
psychological stress.

22. INTRA- OPERATIVE
Three groups of personnel are involved in the
care:-
• The anaesthetic team
• The surgical team
• The operating room nurses

23. Nursing diagnosis of the intra-operative
client
• potential for risk of aspiration related to the position used for surgery and
anaesthesia .
• Potential for impaired skin integrity related to surgical incision and
infection.
• Potential for altered tissue perfusion related to anaesthetic drugs.
• Potential for risk of fluid volume deficit related to loss of body fluid during
surgery.
• Potential for risk of altered body temperature related to :-
---lowered room temperature of OT
---infusion of cold fluids
---inhalation of cold gases
---decreased muscle activity
---advanced age

24. POST-OPERATIVE
• preparation of post-anaesthetic bed and
reception of the patient
• Care of the patient who is under the effects of
anaesthesia.
• Keen observation
• Care of the wound
• Diet
• Post operative health teaching

25. • Ineffective airway clearance related to medications and anaesthetic agents.
• Ineffective breathing pattern related to pain, surgical incision and medications
• Risk for altered body temperature
• Risk for injury related to post anaesthetic status
• Pain related to surgical incision
• Altered nutrition ,less than body requirements
• Risk for fluid volume deficit related to loss of fluid during surgery and
inadequate intake of fluid after surgery
• Nausea and vomiting related to gastrointestinal distension medication,
anaesthetic effect and stimulation of vomiting centre or chemoreceptors trigger
zone.
• High risk for infection related to surgical incision ,inadequate nutrition and
fluid intake ,invasive catheter and immobility.
• Altered urinary elimination related to decreased activity ,effects of medications,
and reduced intkae of fluid.
Nursing diagnosis of the post-operative
client

26. Cont…
• Constipation related to decreased gastric and intestinal motility during
intra-operative period.
• Impaired physical mobility related to depressant effects of anaesthesia,
decreased activity tolerance and prescribed activity restrictions.
• Potential for haemorrhage related to ineffective vascular closure.
• Potential for thromboembolism related to dehydration ,immobility, vascular
manipulation or injury.
• Self care deficit related to ananesthesia and surgery.
• Impaired home management related to lack of knowledge about follow up
care.