Cardiovascular disorders are one of the leading causes of death in the United States, and although the incidence of rheumatic heart disease has declined significantly, the incidence of valve disease is still one of the three major cardiovascular disorders encountered, resulting in more than 200,000 heart valve replacements or repairs worldwide each year (Brown, 1998). Mitral valve replacement surgery can be performed using mechanical valves, tissue valves, or homografts (Strong, 2004). Mechanical grafts are the most reliable and durable of the three grafts, but require the patient to take blood thinners, and have regular blood work followup. Tissue grafts made from other biological tissues operate in a similar manner to human valves, and so blood thinners are not needed, but they usually have to be replaced after about 15 years. Homografts from donated human hearts cause less risk of infection and also do not require the use of blood thinners, but involve a more complex replacement surgical technique.
Mitral valve prolapse occurs when the mitral valve does not open and close properly and blood may leak backward into the left atrium (Papp, 2001). The changes occurring in the valve are brought about by the rapid proliferation of cells from the middle layer of the valve, pressing on the outer valve layer and causing it to weaken and resulting in a prolapse into the left atrium. In many cases, the disease in innocuous, but in severe cases, repair or replacement may be required.
Pre-surgical clinical manifestations of the disease process
The signs and symptoms of mitral valve prolapse vary, and include sharp, left-sided pain in the chest, pounding in the chest, fatigue, or an irregular heart beat, swelling of the ankles, difficulty breathing, and fluid in the lungs. The conditions is rarely fatal. Diagnosis is made during the physical exam in which the physician may hear a clicking sound and/or a heart murmur. An echoca...