There are four types of valves in the human heart – the mitral, aortic, tricuspid, and pulmonary valve. The mitral and the tricuspid valve are present between the upper and the lower chambers of the heart. On the other hand, the aortic and the pulmonary valve are present in the two arteries that leave the heart.
Most often, it is the mitral and the aortic valve that undergoes certain pathologic changes due to degenerative valve diseases, rheumatic heart diseases, or infective endocarditis. This may result in problems associated with the valve opening and closure.
These dysfunctions can be treated with either valve repair or valve replacement surgery. Aortic valve replacement or mitral valve replacement is carried out when just one of the valve is diseased or damaged. However, when both the valves are diseased or damaged, a double valve replacement surgery is conducted.
The heart valves present in the heart are responsible for permitting the flow of nutrient-laden blood through the heart chambers. After allowing the ushering of blood, each valve is expected to close completely. The diseased or damaged valves are not able to open and close properly, thus allowing the mixing and backflow of blood (regurgitation).
A double valve replacement surgery mainly aims at correcting the problem of valvular heart disease and involves both aortic valve replacement and mitral valve replacement. The mitral valve is situated between the left atrium and the left ventricle while the aortic valve is located in between the aorta and the left ventricle.
Some of the causes of heart valve disease include the following:
Some of the symptoms of valvular heart disease include the following:
Double valve replacement surgery is a complicated procedure as compared to single valve replacement surgery. Aortic valve replacement and mitral valve replacement involves the replacement of just one valve but during double valve replacement surgery, both the diseased valves are removed at the same time and replaced with a synthetic (mechanical) or a biological valve.
In the case of mechanical valves, the components used are not of organic or natural origin. They are created from a combination of polyester and carbon material that the human body can tolerate and accept. Blood-thinning medications are given to patients who get mechanical valves to prevent blood clot formation.
Bioprosthetic valves or the biologic valves are either created from animal or human tissues and can be of the following types:
The choice of a particular type of valve depends on the age, overall fitness, and the ability to metabolize anticoagulant medications. The only problem associated with a bioprosthetic valve is that it may not last a lifetime and one may have to undergo a replacement again later.
For the purpose of hemodynamic monitoring, the peripheral arterial and venous access are installed. The patient is anaesthetized in a supine position with a single lumen endotracheal tube.
In the jugular vein, two percutaneous sheath introducers are placed for central venous pressure monitoring and drug administration. Another similar one is placed in the same right jugular vein for the purpose of introducing endocavitary pacemaker leads if required. External defibrillator pads are placed on the patient’s back and on the anterior left chest.
TEE or transesophageal echocardiography probe is used for an assessment of cardiac function, percutaneous venous cannulation guidance, and valve assessment. The skin is sterilized with iodine solution and an aseptic strip is applied on areas exposed. The double valve replacement procedure is very similar to isolated aortic valve replacement or mitral valve replacement, which is conducted via a single access right anterolateral minithoracotomy.
Before systemic heparinization, the venous introducer sheath is positioned in the femoral vein to prevent any unwanted bleeding. In the third intercostal space, an incision of 6 to 8 cms is made. Minithoractomy is made and in the 3rd and 5th intercostals spaces, two auxiliary working ports are placed. The first is for video assistance and the second is for gas insufflation, cardiotomy vent, and pericardial stay sutures. The pericardium is opened upwards and downwards after removal of the pericardial fat, which is 3 to 4 cm above the phrenic nerve. The pericardium is retracted using silk sutures.
In a standard way, two aortic purse strings are placed for direct arterial cannulation after the aorta has been exposed. The operation is continued with venous cannulation under the guidance of TEE. A guidewire in moved through the venous introducer and positioned in the superior vena cava.
With the central cannulation of the ascending aorta, arterial inflow is established. The cannula has an obturator and an advanced tip to aid aortic insertion within the thorax. With cannula rings, the tip is secured and with two tourniquets the cannula is secured. They allow maximum space to work during thoracotomy access.
Carbon dioxide flow keeps running and when the heart gets arrested, the aorta is opened in an oblique way with an incision like a hockey stick, k which is further extended to the non-coronary sinus Valsalva. After this, aortotomy is made far away from the cross-clamp and from the main pulmonary artery trunk; for the closure of aortotomy, enough aortic tissue must be kept. Now the problematic valve is excised. The annulus size is measured and calibrated with a sizer and then prosthesis is implanted. The aortic prosthesis is lowered and made to remain above the final plane of implantation.
Now focus shifts to the left atrium. It gets dissected in a Sondergaard’s plane, and with the help of one single silk suspension stitch and an atrial retractor, the mitral valve is exposed. If now required the left atriotomy can be further extended behind upwardly behind the superior vena cava or along the inferior vena cava downwardly. In right minithoracotomy the visualization of the mitral valve is very good and allows valve and subvalvular repairs easily.
The procedure starts with synthetic braided sutures being placed in the mitral annulus whose diameters are measured using suitable valve sizes. For the mitral valve, reductive annuloplasty is performed. The sutures are passed and the retractor is removed and then attention is again diverted towards the aortic valve prosthesis. This is lowered into the annular plane and thereafter knotted.
For the assessment of the results of the repair, the atrial retractor is again positioned in the left atrium. To estimate the competence of the valve, a water probe is applied with an implanted open mitral ring. After successful completion, the left atrium is closed leaving behind the ventricular vent via the mitral valve in the left ventricle. Aortic cross-clamp is removed and aortotomy suture is further knotted. The aortic vent is positioned in the ascending aorta. A polypropylene purse-string suture is hand-knotted after aortic vent is removed. After confirmation by the TEE, the procedure moves to the final stage where the aortic cannula is removed and a percutaneous cannula is also withdrawn with the femoral vein temporarily placed under compression, the skin incision is closed with a single silk stitch.
After the surgery, the patient is shifted to ICU for close monitoring for several days. Blood pressure, ECG tracing, breathing rate, and oxygen levels are closely studied. You may require staying in the hospital for several days after heart valve replacement surgery. With the help of the ventilator, breathing is assisted via a tube inserted in the throat. The breathing machine will be further adjusted as the patient keeps growing stable and once the patient is able to breathe and cough on their own, the tube is removed. Along with this, the stomach tube is also removed.
In every two hours, a nurse would help the patient take deep breaths and cough. This feels sore but is vital to prevent accumulation of mucus in the lungs and prevent pneumonia. The patient is taught to hug a pillow tightly while coughing to ease out any discomfort. The patient must express discomfort felt at coughing and medications are suggested accordingly. Slowly fluid intake is initiated and you can gradually increase your daily activities such as walking around the room. After a few days, the patient is shifted to the recovery room where the rest of the recovery takes place before discharge.
Notify your doctor if you feel swelling and redness around incision area, fevers and chills, or pain in the area of the incision. You should rest and keep the surgical area as clean as possible at home.
On an average, Heart Double Valve Replacement in Czechia costs about $45000. Only some of the best and certified hospitals in Czechia perform Heart Double Valve Replacement for international patients.
The Heart Double Valve Replacement package cost in Czechia varies from one hospital to another and may offer different benefits. There are many hospital that cover the cost of pre-surgical investigations of the patient in the treatment package. The treatment cost usually includes the expenses related to hospitalization, surgery, nursing, medicines, and anesthesia. A prolonged hospital stay due to delayed recovery, new diagnosis and complications after surgery may increase the cost of Heart Double Valve Replacement in Czechia.
There are several best hospitals for Heart Double Valve Replacement in Czechia. Some of the most renowned hospitals for Heart Double Valve Replacement in Czechia include the following:
Upon discharge from the hospital after Heart Double Valve Replacement in Czechia, the patients are advised to stay for about 21 days for recovery. This time frame is important to ensure that the surgery was successful and the patient is fit to fly back.
While Czechia is considered to be one of the best destinations for Heart Double Valve Replacement owing to the standard of Hospitals, and expertise of doctors; there are a select few destinations which provide comparable quality of healthcare for the procedure Some of the other destinations that are popular for Heart Double Valve Replacement include the following:
|Saudi Arabia||USD 33000|
|South Korea||USD 70000|
|United Arab Emirates||USD 45000|
There are certain additional cost that the patient has to pay apart from the Heart Double Valve Replacement cost. The per day cost in this case may start from USD 50 per person.
There are many cities that offer Heart Double Valve Replacement in Czechia, including the following:
After the Heart Double Valve Replacement takes place, the average duration of stay at the hospital is about 5 days. During the recovery, the patient is carefully monitored and control tests are performed to see that everything is okay. If required, physiotherapy sessions are also planned during recovery in hospital.
There are more than 1 hospitals that offer Heart Double Valve Replacement in Czechia. The above listed hospitals are approved to perform the surgery and have proper infrastructure to handle Heart Double Valve Replacement patients. These hospitals comply with all the rules and regulations as dictated by the regulatory bodies and medical association in Czechia
The JCI or Joint Commission International is a renowned accredition body present in over 100 countries. It also accredites hospitals and clinics in Czechia as well. The hospitals and clinics in Czechia sustain their healthcare quality and patient safety standards and earn their JCI certification. There are numerous healthcare organisations in Czechia that bear the approval from Joint Commission International for their quality maintenance. The organisation management of any hospital or clinic in Czechia or the patient care levels are ensured by their certification from Joint Commission International.
Here are some of the popular multispecialty hospitals in Czechia::
The many advanced multispecialty hospitals in Czechia are the main reason behind its popularity as a sought after medical tourism destination. The multispecialty hospitals in Czechia make it possible for any patient to get the treatment they deserve across any specialty at reasonable cost. The Czechia multispecialty hospitals’ are equipped with the latest technologies which are upgraded regularly so that the healthcare is equivalent to the best anywhere in the world.
You should opt for healthcare in Czechia because the healthcare systems in Czechia are based on a stringent framework which gives it a lot of credence among all entities be it patients, healthcare professionals, accreditation bodies, private organisations, academicians and governments. You must opt for healthcare in Czechia as the treatment options available in the hospitals and clinics in Czechia are at affordable prices. This is in addition to the wide variety of treatments being performed here everyday. Medical travellers to Czechia are aware of the high standards of healthcare and their continuous maintenance and this is a really good reason for you to opt for healthcare in Czechia as well. It is important to know that you can benefit from a wide health insurance coverage that gives free medical care to Czech citizens, permanent residents, any foreigner working in a local company and European Health Insurance Card (EU Citizens) and Global Health Insurance Card (for UK citizens). Others can choose from travel health insurance (less than 90 days stay) and numerous private healthcare schemes (for over 90 days stay)."
The doctors in Czechia are educated from the most reputed universities and have several decades of on field training and experience in their area of expertise. The quality of treatment given and procedures performed by the doctors in Czechia are synonymous with high success rates. The good quality doctors in Czechia are definitely world renowned for their immense contribution to the medical field. In Czechia hospitals, the doctors are efficient and thorough right from understanding the health issue the patient is facing to the treatment to the post operative care.
The essential documents that you need to carry for your medical treatment journey to Czechia are:
You must carry travel and treatment related documents on your medical travel to Czechia. The documents that show that your finances can support your treatment need to be carried with you as well (either self financing or through sponsorship and insurance). It is wise for you to be well prepared with your travel and medical documents during your medical travel to Czechia that align with your itinerary and your medical history. Your medical travel to Czechia should be easy and effortless if all your important travel and medical documents are in order.
The popular procedures performed in Czechia are as follows:
Weight loss procedures like Sleeve Gastrectomy and Gastric Bypass are being commonly performed in Czechia with high success rates and attracting lots of medical tourists every year. When it comes to managing disease and injury in our musculoskeletal system, the healthcare system in Czechia is progressing well with Knee replacement and Hip replacement procedures attracting many medical travellers to Czechia each year. Among the popular procedures being performed in Czechia, Microdiscectomy and Spinal Fusion are a sign of the strong spinal surgery base in the hospitals in the country.
When you are near your departure date to Czechia, please take your vaccinations as it is essential to be protected from potential health hazards before you begin your medical travel. Here are the vaccinations that are a must for any medical traveller who is headed to Czechia for their treatment:
Among the vaccinations that are to be taken before your Czechia medical trip are those that are routine and those basis age specifics and potential health hazards. It would be good to double check the vaccinations that you need to take well in advance of your journey to Czechia for your medical treatment from the World Health Organisation, a United Nations arm and Centers for Disease Control and Prevention, a US agency.
Please find below the additional facilities that hospitals in Czechia provide to patients and the people accompanying them to ease their stay for treatment:
The international patient care facilities in major hospitals in Czechia are manned by healthcare and administration professionals with long term experience in international patient management. When you come to get your medical treatment for your condition in any major hospital in Czechia, you will need to liaison with only a single point of contact who will ensure that your international, local travel and hospital transfer is made seamless. This is a great facility that is available for all medical travelers to Czechia. The additional facilities for medical travelers coming to hospitals in Czechia include physiotherapists, pharmacies and laboratory services.
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