Tran, 73, sought medical attention for acute shortness of breath and was admitted to Tam Anh General Hospital Ho Chi Minh City with heart failure. Doctors diagnosed severe mitral valve regurgitation (4/4), attributing it to ruptured chordae and valve prolapse. Her condition was further complicated by a moderate bilateral pleural effusion. Analysis of the pleural fluid confirmed it was transudative, consistent with acute heart failure and pulmonary edema caused by the severe mitral valve regurgitation and chordae rupture. This critical diagnosis highlighted the urgent need for intervention.

The mitral valve plays a crucial role in heart function, preventing blood from flowing backward from the left ventricle into the left atrium during contraction. When the valve fails to close properly, this backflow forces the heart to work harder, a strain that, over time, can lead to heart failure.

Mitral valve regurgitation can stem from various causes: post-rheumatic heart disease, myxomatous degeneration, calcific degeneration, or congenital defects such as valve prolapse, a cleft valve, or abnormally short chordae. Infective endocarditis is another potential cause. In Tran's case, degenerative valve disease, valve prolapse, and ruptured posterior leaflet chordae led to the sudden onset of severe mitral valve regurgitation, acute shortness of breath, and decompensated heart failure. She had a two-year history of managed hypertension and dyslipidemia, with no prior heart valve disease.

Beyond the severe mitral valve regurgitation, coronary angiography revealed severe stenosis in two coronary arteries. The medical team, led by Doctor Nguyen Thi Ngoc, Master of Science, Level 2 Specialist, from the Department of Cardiology 2, Heart Center, Tam Anh General Hospital Ho Chi Minh City, planned a comprehensive surgical approach: a combined heart valve repair and coronary artery bypass graft. This strategy aimed to simultaneously address both dangerous cardiovascular conditions. Before surgery, Doctor Ngoc focused on stabilizing Tran's heart failure to optimize her health.

Doctor Vien and the team performed combined heart valve repair and coronary artery bypass graft surgery for the patient. Photo: Tam Anh General Hospital

Doctor Nguyen Minh Tri Vien, Master of Science, Cardiac Surgery Consultant at Tam Anh General Hospital Ho Chi Minh City's Heart Center, determined that Tran's valve damage and subvalvular structures were repairable, eliminating the need for replacement. This assessment confirmed the viability of the planned combined heart valve repair and coronary artery bypass graft procedure.

Post-operative ultrasound confirmed the success of the surgery. The mitral valve demonstrated optimal opening and closing, ensuring smooth atrioventricular flow. Furthermore, the two coronary bypass grafts functioned effectively, restoring and expanding blood flow to the heart muscle.

Tran's recovery was marked by minimal post-operative pain, thanks to a combined general anesthesia and erector spinae plane block, which reduced the need for morphine. Following the operation, her shortness of breath resolved, she regained the ability to walk independently, and her heart function steadily improved. She was discharged after 7 days, marking a significant recovery.

According to Doctor Ngoc, mitral valve regurgitation varies in severity. Mild cases typically require annual monitoring rather than immediate treatment. For moderate to severe regurgitation without symptoms, initial treatment involves medication. If medication proves insufficient, valve repair or replacement surgery is then considered.

Patients who undergo surgery must adhere to prescribed medication regimens and attend regular follow-up appointments. To prevent infective endocarditis, a common cause of mitral valve regurgitation, individuals should maintain a clean living environment, ensure regular dental check-ups, and promptly treat sore throats. Symptoms such as fatigue, shortness of breath, chest pain, palpitations, irregular heartbeat, prolonged tiredness, or reduced exercise capacity warrant immediate medical attention.

Thu Ha

* Patient's name has been changed