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 cost of Heart Double Valve Replacement procedure starts from USD 9500 in Tunisia. There many TEMOS certified hospitals in Tunisia that offer Heart Double Valve Replacement
The cost of Heart Double Valve Replacement in Tunisia may differ from one medical facility to the other. The top hospitals for Heart Double Valve Replacement in Tunisia covers all the expenses related to the pre-surgery investigations of the candidate. Typically, the package cost of Heart Double Valve Replacement in Tunisia includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. Stay outside the package duration, post-operative complications and diagnosis of a new condition may further increase the Heart Double Valve Replacement cost in Tunisia.
The recovery of the patient many vary, depending on several factors. However, on an average, patient is supposed to stay for about 21 days in the country after discharge. This time frame is important to ensure that the surgery was successful and the patient is fit to fly back.
While Tunisia 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 such countries are:
|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. These charges starts from USD 50 per person.
The following are some of the best cities for Heart Double Valve Replacement in Tunisia:
The average duration of stay at the hospital after Heart Double Valve Replacement is about 5 days for proper care and monitoring. The doctors team review the patient's recovery during this time with the help of blood tests and imaging scans. Once they feel that everything is on track, the patient is discharged.
There are more than 4 hospitals that offer Heart Double Valve Replacement in Tunisia. Such hospitals have the required infrastructure and a dedicated unit where patients can be treated. These hospitals comply with all the rules and regulations as dictated by the regulatory bodies and medical association in Tunisia
The most popular multispecialty hospitals in Tunisia are:
It is widely known that hospitals and clinics in Tunisia function with unmatched service delivery and bring a personal touch to the treatment of patients. The finesse and efficiency with which multispecialty hospitals in Tunisia diagnose and treat health conditions is admirable. The world class infrastructure in the healthcare institutions such as hospitals and clinics in Tunisia are a good reason for you to opt for treatment in Tunisia.
You must opt for healthcare in Tunisia because of the cutting edge infrastructure of its hospitals and clinics. You must choose to get your healthcare from Tunisia as the hospitals and clinics here are composed of really qualified and skilled medical, paramedical and administrative professionals. You can choose to get healthcare from Tunisia because of the lower costs, lesser waiting times and an all embracing approach to healthcare right from consultation to treatment follow ups or rehabilitation. The safety, security and the cleanliness standards of Tunisia and healthcare in Tunisia respectively makes it an attractive destination to get your healthcare from.
The quality of doctors in Tunisia is very good as they have had the best of practical training and experience and this translates into their strong ability to treat patients successfully even when working under pressure for long hours. In their quest to learn and apply that knowledge to treat patients satisfactorily, the doctors in Tunisia get the best of education and upgrade their qualifications throughout their career. As a patient, you feel confident in your doctor in Tunisia as they are known to be good managers; they have to liaison with fellow doctors, other healthcare professionals, hospital personnel and leading teams when performing procedures successfully. It must be put forth that the doctors in the Tunisian healthcare system are good in people skills and thus great at managing relationships with fellow doctors and healthcare professionals and in leading teams.
The important documents that are needed for your medical travel to Tunisia are mentioned here for your convenience:
Please ensure that the documents you carry to Tunisia must cover the requirements of the journey from your country of origin to your treatment and the journey back home. The Government of Tunisia is now introducing an online visa application process which would ease your medical travel preparation to Tunisia. An essential document for your medical travel to Tunisia, the medical visa would now be easier to get with the introduction of a more seamless online visa application process.
The popular procedures available in Tunisia are as follows:
It is the Spine and Orthopaedic treatments that are making waves in the medical travel industry in Tunisia. The advanced Breast Cancer treatment is making sure that a lot of medical travellers are heading to Tunisia to get a new lease of health and life. The types of popular procedures being performed everyday in Tunisia are growing in number and scope but of the existing ones, gynecological procedures such as fibroid removal surgery are performed routinely.
Are you planning to go to Tunisia? Then please have a look at the vaccinations that you need to take before starting on your journey.
The recommended and routine vaccinations before medical travel to Tunisia are advised by CDC: The Centers for Disease Control and Prevention, the US agency and WHO: World Health Organisation, a UN body. There are certain vaccines that are linked to potential health conditions such as Hepatitis A, Hepatitis B, Rabies and Typhoid. There are other vaccines which are considered routine or regular for conditions that you must be protected from at all times. As you begin to plan your medical travel to Tunisia, make sure that you are vaccinated against the many ailments atleast a month prior irrespective of recommendation by a health agency.
There are many additional facilities provided by the hospitals in Tunisia which enhance your medical travel experience. We have listed here the many additional facilities that the hospitals in Tunisia give the medical tourists.
In Tunisia, the healthcare organisations make it possible for you to ascribe to virtual consultations pre treatment and engage in evaluations and follow ups through virtual mediums. There are other facilities that are in hospitals in Tunisia like presence of dietitians, physiotherapists and prayer rooms.
There are many great medical tourism destinations in Tunisia which is because of a combination of wonderful tourist places and excellent medical infrastructure. The medical tourism destinations within Tunis are outlined here:
In the 2020-21 Medical Tourism Index listing 46 countries, Tunisia has a good ranking of 38. This is because of the focus on healthcare, having good relationships with the European union and Arab nations and a strong tourism industry. Tunisia is on the fast track to growth as a sought after medical tourism destination because it provides excellent healthcare at competitive prices, an easy to get medical visa and warm hospitality shown by the people in Tunisia.
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