The valves are responsible for delivering rich oxygenated blood to the heart chambers. In total, there are four heart valves performing the same operation. Each valve closes completely after pushing the blood in the following chamber. Hence the flow is maintained. The ill-conditioned heart valve is incapacitated to perform this operation. When the blood vessels narrow, the lesser amount of blood flows in the chambers causing the heart muscles to work harder. This condition is called stenosis. Weak valves cause disruptive flow of blood as the valve sometimes may close lightly. This causes the blood to flow backward which is termed as regurgitation.
Getting a valve replacement means to replace the faulty valves with either mechanical or biological alternatives. Replacing both the mitral and the aortic valves is called double valve replacement, or the entire left side of the heart. This type of surgery is not as common as the others and the mortality rate is slightly higher.
Figuring out the right candidate for the double valve replacement can be a little tricky as the procedure is a bit uncommon. Also, the factors involved in deciding who should get the replacement would vary from person to person. A general viewpoint may lead to patients having these symptoms.
Other factors that play an important role in deciding the candidature of double valve replacement are:
The factors affecting the cost of double valve replacement procedure may depend on:
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.
The Heart Double Valve Replacement package cost in South Africa varies from one hospital to another and may offer different benefits. The Heart Double Valve Replacement package cost usually includes all the expenses related to pre and post surgery expenses of the patient. The Heart Double Valve Replacement procedure in South Africa includes the fees of the surgeon, hospitalization and anesthesia as well. Extended hospital stay, complications after the surgery or new diagnosis may affect the overall cost of Heart Double Valve Replacement in South Africa.
After discharge from the hospital, the patient has to stay for another 21 days in the country for complete recovery. This time frame is important to ensure that the surgery was successful and the patient is fit to fly back.
While South Africa 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|
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 cost in this case may start from USD 50 per person.
Some of the best cities in South Africa which offer Heart Double Valve Replacement are:
The patient has to spend about 5 days in the hospital after Heart Double Valve Replacement for proper recovery and to get clearance for discharge. 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.
The average rating for Heart Double Valve Replacement hospitals in South Africa is 2.9. This rating is automatically calculated on the basis of several parameters such as the infrastructure of the hospital, quality of services, nursing support and other services.
There are more than 3 hospitals that offer Heart Double Valve Replacement in South Africa. Such hospitals have the required infrastructure and a dedicated unit where patients can be treated. Such hospitals follow all legal protocols and guidelines as specified by the local medical affairs body when it comes to the treatment of international patients.
South Africa has several top-quality hospitals, such as:
These hospitals have taken the patient experience to the next level by ensuring the below things:
Providing world-class treatment, the hospitals comply with strict healthcare laws and also adhere to medical protocols and international standards to ensure quality care. Supported by state-of-art infrastructure, advanced medical equipment, and highly qualified doctors, the hospitals offer various facilities to improve the patient experience.
In South Africa, the healthcare system is bound to follow standards set by the Joint Commission International (JCI) and Council for Health Service Accreditation of Southern Africa (COHSASA). To ensure that integrated and coordinated care is provided, COHSASA develops as well as measures standards in all areas and departments of a healthcare facility. COHSASA, JCI, and SafeCare Foundation have come together to launch the SafeCare program to implement internationally recognized standards to improve health care delivery. Hospitals and clinics that initially and meet standards are awarded two-year accreditations and as the journey in excellence continues, awards of longer duration are given.
A large number of medical tourists visit South Africa every year due to low-cost treatment and modern infrastructure. South Africa has become the epicenter of medical tourism because of several other reasons like advanced technology, several facilities provided by hospitals, doctors trained abroad, and a large pool of accredited hospitals. In addition, South Africa’s liberal laws allow for the use of stem cells in medical practice, making it an invaluable destination for patients in need of advanced medical treatment. You get comprehensive treatment at world-class hospitals which assist you with all organization and administrative tasks and also provide you all-inclusive care and assistance on a 24/7 basis.
With quality at their core, the well-trained and highly qualified doctors in South Africa provide world-class treatment. Majority of doctors in South Africa have received rigorous training in countries like Cuba and Australia which makes them competent in dealing with even the most complicated cases with great ease. The doctors deliver great results in dental procedures and fertility treatments and provide complete patient satisfaction through a holistic approach. There are several reasons why South Africa has a large pool of quality doctors, such as education at reputed colleges, compliance with global standards, using human touch in treatment, and adopting a patient-centric approach.
A person can apply for a medical visa to South Africa for a period of 90 days. The High Commission helps one decide for how long a visa can be extended. People must apply for a temporary residency permit if they require medical treatment for longer than three months. The validity of a visa begins the same day it is issued by the High Commission in South Africa. A visa application is accepted until 30 days prior to the departure date. Make sure you have the below-listed documents while applying for a medical visa:
Some popular procedures available in South Africa are hip replacement, anterior cruciate ligament (ACL) reconstruction, total knee replacement, meniscus repairs. Besides offering these popular procedures, South Africa also attracts many medical tourists for cosmetic surgery and infertility treatment. Egg donation program is very popular in the country and you have an option of having either a surgical or non-surgical procedure, with very low waiting times. The reasons for the popularity of these procedures are affordable treatment cost, speedy recovery, use of advanced technology, and highly trained doctors.
Some popular cities of South Africa that attract a huge number of medical tourists every year are Cape Town, Johannesburg, Pretoria, and Durban. Cape Town, which attracts a wide variety of people from different ethnicity and cultures, has world-class doctors and state-of-the-art medical facilities. Besides providing quality treatment, these cities are also known for having a better public transportation system, cheap hotels, and connectivity through airlines. Johannesburg’s healthcare system is on par with Great Britain and the city’s public and private healthcare industry works closely with South Africa's medical schools to create internationally recognized medical specialists.
Yes, some vaccines are highly recommended or required for South Africa. WHO and the National Travel Health Network and Centre recommend the following vaccinations: hepatitis A, yellow fever, rabies and tetanus, hepatitis B, typhoid, cholera. Make sure that infants of age 6 to 11 months get measles-mumps-rubella (MMR) vaccine before they travel to South Africa. Typhoid vaccine is recommended for most travellers, especially those staying with friends or relatives or visiting smaller cities or rural areas. You can connect with your doctor or the hospital in South Africa for the required vaccines. Also, refer to the travel advisory issued by the government.
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