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.
Different hospitals have different pricing policy when it comes to the cost of Heart Double Valve Replacement in Malaysia. The cost quoted by some of the best hospitals for Heart Double Valve Replacement in Malaysia generally covers the pre-surgery investigations of the patient. Typically, the package cost of Heart Double Valve Replacement in Malaysia includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. Extended hospital stay, complications after the surgery or new diagnosis may affect the overall cost of Heart Double Valve Replacement in Malaysia.
Many hospitals in Malaysia perform Heart Double Valve Replacement. The following are some of the most renowned hospitals for Heart Double Valve Replacement in Malaysia:
After Heart Double Valve Replacement in Malaysia, the patient is supposed to stay in guest house for another 21 days. This is important to ensure that the surgery was successful. During this time, control and follow-up tests take place to check for medical fitness.
Malaysia is one of the most popular countries for Heart Double Valve Replacement in the world. The country offers the best cost of Heart Double Valve Replacement, best doctors, and advanced hospital infrastructure. However, there are other countries as mentioned below that are popular for Heart Double Valve Replacement as well:
|Saudi Arabia||USD 33000|
|South Korea||USD 70000|
|United Arab Emirates||USD 45000|
Apart from the Heart Double Valve Replacement cost, the patient may have to pay for additional daily expenses such as for guest house after discharge and meals. The per day extra expenses in Malaysia per person are about USD 50 per person.
Some of the cpopular cities in Malaysia that offer Heart Double Valve Replacement include the following:
The patient is supposed to stay at the hospital for about 5 days after Heart Double Valve Replacement for monitoring and care. 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 Malaysia. The above mentioned hospitals have the required infrastructure and a dedicated unit where patients can be treated. Additionally, these hospitals are known to comply with the international standards as well as local legal requirements for the treatment of patients.
Malaysia has a large pool of quality hospitals, such as:
These hospitals are supported by the latest medical technologies and superior infrastructure, ensuring world-class treatment. The hospitals in Malaysia are advanced due to more support from the government through investment in medical infrastructure. Supported by excellent facilities and well-trained staff, the hospitals in Malaysia have witnessed tremendous growth and are on par with well-developed countries.
In Malaysia, most hospitals are accredited by Malaysian Society for Quality in Health (MSQH) and JCI. Presently, there are 12 JCI-accredited hospitals in Malaysia and all of them ensure that they meet global standards. MSQH, Malaysia’s Ministry of Health, Association of Private Hospitals Malaysia and Malaysian Medical Association have come together to raise the standards of healthcare in Malaysia. The process of receiving healthcare accreditation in Malaysia is very stringent and the hospitals are strictly evaluated on quality parameters.
Solid public-private healthcare collaboration and governmental participation have contributed to a strongly-built healthcare system in Malaysia, making it one of the most favored destinations for medical tourists. Slowly overtaking many other countries as a medical tourism destination, Malaysia is offering affordable healthcare services with cutting-edge technology and skilled professionals. Malaysia is attracting a large number of medical tourists every year for cardiology and fertility treatments. Malaysia has a rich culture and several heritage spots which make it one of the most popular medical tourism destinations in the world.
Malaysia has highly trained doctors and many of them are trained internationally before returning to work in their home country. Malaysia has a very stringent evaluation process for doctor’s certification and all medical professionals have to complete three years of service in the public sector to ensure they have achieved an extreme level of professionalism. Doctors in Malaysia have received worldwide recognition for their high success rates in IVF and cardiac procedures. Malaysia offers all medical tourists the facility of applying for eVisa for traveling to the country for treatment and reside there for a period of 30 days.
Medical tourists can apply for eVisa for traveling to Malaysia to get medical treatment and reside there for a period of 30 days under the Malaysian Healthcare Travellers Program (MHTP). eVISA remains valid for 3 months and it can be availed through online platforms. You need to provide the following things to obtain an eVisa:
Medical Attendant Visa is granted to the person accompanying the patient to Malaysia and two persons are allowed to travel with the patient.
The popular procedures available in Malaysia are cosmetic surgery, vitiligo treatment, cancer care, dental work, discectomy, prostate surgery. Malaysia has effectively treated a large number of cancer patients through gene therapy which brings several benefits like reduced treatment costs, shorter treatment time, and minimal adverse effects of current chemo-drugs. Hospitals and clinics in Malaysia are equipped with the latest technology to perform Assisted Reproductive Technique (ART) procedures such as In Vitro Fertilization (IVF), which has a marvelous success rate of 55 to 60. Malaysia has also reported great achievements in orthopedic surgeries and some of the popular procedures include hip replacement, shoulder replacement, knee replacement surgery.
Malaysia has some top cities having world-class hospitals, such as:
With highly trained and qualified doctors and a large pool of multispecialty hospitals, Malaysia offers a great medical travel experience. Both Penang and Kuala Lumpur are the centres of attraction for medical tourists as they are serviced by airlines from around the world; have a number of reasonably-priced hotel rooms and an excellent public transportation system. These cities are most preferred by medical tourists because of many other reasons like a large number of hospitals, rich culture, scenic value, availability of translators, and safety of tourists.
A medical tourist traveling to Malaysia needs to get below vaccines:
Pre-exposure vaccination against rabies is recommended before travel to Malaysia and children are at greater risk of rabies. Japanese encephalitis is common in Malaysia and can be prevented through vaccination. Travellers arriving from countries with a risk of Yellow Fever may need an International Certificate of Vaccination.
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