Double valve replacement involves the replacement of both the mitral and the aortic valves that are either damaged or defected. Both these valves are present on the left side of the heart. This surgery is not as common as single valve replacement surgery and the mortality rate associated with this procedure is slightly higher than the replacement of a single valve. During this surgery, the defected or damaged valves are either replaced with synthetic valves or biological valves.
Patients requiring double valve replacement can comfortably travel to Thailand for this surgery. The best cardiac care hospitals in Thailand are equipped with the latest technology and modern facilities. Moreover, the state-of-the-art infrastructure at these hospitals intends to make the journey of the patients comfortable and make medical care a holistic experienced for patients. This surgery is performed by a team of highly experienced cardiac surgeons who are mostly trained and educated from abroad.
Double valve replacement cost in Thailand is greater than the cost of single valve replacement surgery. The cost of this surgery depends on various factors, including the fees charged by the surgeons, the total duration of hospital stay, and the number of days spent in the cardiac intensive care unit. Some of the other factors include the cost of medicines, hospital charges, and the cost of tests conducted before and after the surgery.
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.
Heart Double Valve Replacement cost in Thailand starts from about $50000. Only some of the best and certified hospitals in Thailand perform Heart Double Valve Replacement for international patients.
The Heart Double Valve Replacement package cost in Thailand 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 Thailand includes the fees of the surgeon, hospitalization and anesthesia as well. There are many things that may increase the cost of Heart Double Valve Replacement in Thailand, including prolonged hospital stay and complications after the procedure.
Many hospitals in Thailand perform Heart Double Valve Replacement. Some of the most renowned hospitals for Heart Double Valve Replacement in Thailand include the following:
After discharge from the hospital, the patient has to stay for another 21 days in the country for complete recovery. During this time, the patient undergoes medical tests and consultations. this is to ensure that the treatment was successful and the patient us safe to return.
While Thailand 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 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 cost in this case may start from USD 50 per person.
Some of the cpopular cities in Thailand that offer Heart Double Valve Replacement include the following:
The average duration of stay at the hospital after Heart Double Valve Replacement is about 5 days for proper care and monitoring. 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 5 hospitals that offer Heart Double Valve Replacement in Thailand. The above listed clinics are approved to perform the surgery and have proper infrastructure to handle Heart Double Valve Replacement patients. 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.
The Thai healthcare system has abundance of resources, from technological, human resources and financial resources. The strength of Thai healthcare is in the healthy symbiois of its public healthcare and private healthcare systems. The quality of healthcare and its standards are maintained by the Institute of Hospital Quality Improvement and Accreditation (HQIA) as it gives Thai HA Accreditation to healthcare organisations in Thailand. This body also aims to bring a marked improvement in service delivery in Thai public and private hospitals.
The clinical care and hospitality in Thailand hospitals is of very high standards. The option of having several specialties at one place makes it easy for any medical traveller to compare and explore their treatment options within several hospitals. The specialst doctors in these hospitals are committed to providing you with the best of treatments available. The famous multispecialty hospitals in Thailand are:
Thailand is a leading healthcare destination in southeast Asia which has been chosen by several medical travellers over the years. Thailand hospitals have International patient services in their topmost multipsecialty hospitals which makes it easy for the medical travelers to travel to Thailand and get treated. All facilities such as embassy and airport transfer assistance, international insurance coordination, interpreters and medical coordinators and concierge services can be found at one place in Thai hospitals. All treatment options from plastic surgeries to tertiary care procedures are found in Thailand hospitals.
Thailand has always been considered to be a one of the top medical destinations in the world. Their doctors and surgeons are considered to be on par with the world's best medical specialists. The doctors are well versed in their field of expertise and their skiils are vouched for by various experts. Two buzzwords are innovation and quality care that mean Thailand doctors excel. Experience in treating international patients has meant that Thai doctors are sought after from the world over.
As you plan your Thailand visit, you start by getting the documents ready. When traveling to Thailand for your treatment, you need to carry travel documents, medical documents and get your finances ready. The documents needed for your medical treatment in Thailand are as follows.:
Thailand is an attractive medical tourism destination. Low prices, excellent healthcare systems and numerous tourist attractions together ensure that remains one. Some of the popular procedures available in Thailand are as follows:
Planning an international travel is incomplete without the necessary immunisations and vaccinations. Do get yourself the necessary protections before you land in Thailand as well. All such vaccinations recommended by CDC and WHO are mentioned here for your convenience. Yellow Fever, Japanese Encephalitis, Measles, Mumps and Rubella (MMR), TDAP (Tetanus, Diphtheria and Pertussis), Chickenpox, Shingles, Pneumonia, Influenza, Rabies, Meningitis, Polio, Hepatitis A, Hepatitis B, Typhoid and Cholera.
The medical and surgical equipment used in Thailand is upgraded regularly with the latest technological advancements. There is a center for international patients in the hospitals in Thailand which caters to all the travel, transfer and accomodation needs of patients and their co travellers. Integrated medical support services and emergency services are present at Thailand hospitals. Radiology services, operating theaters, Intensive care units, cardiac care units, diagnostic laboratory and pharmacies are the different kinds of facilities being provided by Thailand hospitals.
The combination of its excellent existing healthcare infrastructure and the various tourist attractions make Thailand a viable medical tourism destination. Thailand is a bargain as a medical tourist destination and this reflects in the fact that the cost of your travel plus treatment in Thailand is still lower than what you will spend to get treatment done in many other countries. Thailand is not just a beautiful country with rich history, culture and natural beauty but has the best of healthcare facilities and this makes it a strong candidate for medical tourism. The cities of Bangkok and Phuket are the best medical tourism destinations in Thailand.
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