Removal of Valvula Tumor in Patiala: Procedure & Benefits

Valvular tumor excision involves surgical removal of abnormal growths on the heart valves. Tumors within the heart valves are relatively rare and are mostly benign. If a valvular tumor is causing significant issues, such as obstructing blood flow or interfering with the valve's function, surgical intervention may be considered. The goal of the procedure is to preserve heart function. Surgeons may opt for either repairing the valve or replacing the affected valve. This depends on the extent of the damage caused by the tumor. It's important to note that any cardiac surgery involves risks, and the decision to proceed with surgery is typically based on a careful evaluation of the individual patient's overall health, the nature of the tumor, and the potential benefits of the intervention.

A valvular tumor refers to any abnormal growth on a heart valve. The four valves of the heart, namely, the aortic, mitral, tricuspid, and pulmonary valves work by regulating blood in and out of the heart. Any abnormal growths such as tumors in the valves can disrupt the functioning of the heart. The majority of the valvular tumors are benign (non-cancerous) and only a small percent of them are malignant (cancerous). They can be of different types.

• By far, the most common type is a cardiac myxoma. Almost all (90%) of myxomas are attached to the secure skin on the left atrium (the left upper chamber of the heart). Myxomas are usually benign (not cancer).
• Another type of valvular tumor is called a fibroelastoma. These are small, benign (not cancer), and attached to the aortic valve. 
• Sarcomas are the most common type of malignant (cancerous) valvular tumor, but they are rare. Sarcomas most commonly occur in children and teenagers.

Valvular tumor diagnosis typically involves:

• Medical History and Physical Examination: A review of your personal and family medical history will be conducted. A physical examination can show signs such as swelling or abnormal heart rhythms that may indicate the existence of a heart tumor.
• Symptom Assessment: The presence of unusual heart sounds, such as murmurs or the symptoms of shortness of breath, fever, or stroke, will be recorded.
• Echocardiogram (ECG or EKG): It is the primary imaging method that is used to analyze the structure and function of the heart. An echocardiogram gives a detailed image of the heart valves and the surrounding structures. 
• CT Scan/MRI: These tests produce images of the heart's structure and can help visualize a tumor and figure out its size.
• Cardiac Catheterization: This test is sometimes used when the attending physician needs to be fully informed of the heart’s function or needs to examine the coronary arteries for associated problems.
• Blood Tests: These screenings sometimes show anemia or elevated inflammatory markers, which would be indirect signs of a tumor present.
• Biopsy: Rarely, if there is an apparent uncertainty about the diagnosis, the surgeon can take a sample of the tissue and examine it under the microscope. However, an embolism can develop when tumorous material is seen in cardiopulmonary or other locations in the body. For this reason, a biopsy is rarely done.

Once the diagnosis is confirmed, the doctor will plan the treatment and explain the same. Let’s take a look at the various treatment methods available.

Treatment methods for valvular tumors typically focus on surgical intervention, as non-surgical options are limited. Here are the main points for both:

Surgical Treatment Options

• Tumor Resection: It involves the removal of the tumor as well as any involved heart valve tissue if necessary.
• Valve Repair or Replacement: If valve damage by the tumor necessitates surgical repair or valve replacement that can be mechanical or biological.
• Minimally Invasive Surgery: The first choice for removing most tumors is minimally invasive surgery, if feasible, perhaps robot-assisted.
• Emergency Surgery: If the tumor has caused acute valvular obstruction/embolization emergency surgery will be performed.

Non-Surgical Treatment:

• Medical management: Although there is no cure for primary cardiac tumors, medication therapy can be used to manage symptoms until surgery is possible. Medical therapy for primary tumors is the same as for corresponding malignant tumors that have invaded the heart. 
• Radiation Therapy (for malignant tumors):If the valvular tumor is cancerous (malignant), radiation therapy may be considered as part of the treatment plan. Radiation therapy uses targeted beams of radiation to destroy or shrink cancer cells.
• Chemotherapy (for malignant tumors):In cases of malignant valvular tumors, chemotherapy may be recommended to target and kill cancer cells. Chemotherapy is often used in conjunction with other treatments, such as surgery and radiation therapy.

Here’s how valvular tumor removal surgery works.

Before the Surgery

• Preoperative Evaluation: The preoperative evaluation includes a detailed imaging examination of the heart, an evaluation of your medical history, and thorough a physical examination. 
• Risk Assessment: The cardiac surgeon and the patient's cardiologist assess the risk of surgical treatment by considering the patient's overall state of health, age, location of the tumor, and the presence of other concurrent ailments.
• Informed Consent: The surgical team will explain the details of the procedure and obtain an informed consent from you. 
• Preparation: In preparation for the surgery, patients may be started on medications, such as blood thinners. They will be instructed when to stop eating and drinking and what medicine to take on the day of surgery. If they have a cardiac pacemaker or implanted defibrillator, patients should let the surgeon know.

During the Surgery

• Anesthesia: The patient will be administered general anesthesia before the procedure. This will keep him/her unconscious and pain-free during the procedure. 
• Surgical Access: This involves making an incision down the middle of the chest bone.
• Cardiopulmonary Bypass: Most heart tumors will require that your heart be stopped and that you be placed on a heart-lung machine. This machine will serve as your heart and lungs while your heart is stopped.
• Tumor Excision: Once your heart is stopped and your blood has been diverted to the heart-lung machine, your surgeon will remove the tumor. 
• Valve Repair/Replacement: If your valve is damaged and needs to be surgically repaired or replaced, this is often done during the same surgery.
• Closure: Once your surgeon is specific that the repair of your heart has been completed, the cardiopulmonary bypass will be discontinued and your heart will start functioning. The incisions are closed in layers.
   

After the Surgery

• Monitoring: Patients are closely watched for any complications that may arise.
• Pain Management: Some amount of pain and discomfort is common after the procedure. This can be managed with the help of prescribed pain medications. 
• Recovery: Gradually you will able to return to usual activities. Physical therapy might be recommended to help with the progress.
• Follow-Up Imaging: Patients may get an echocardiogram and other imaging studies to ensure that the tumor was removed entirely and that the valve if replaced, is functioning correctly.
• Anticoagulation Therapy: Some patients may need blood thinners, especially if a valve has been replaced with a mechanical valve.

This multi-stage procedure's ultimate objectives are to remove the tumor, repair heart function, and shield against any valvular tumor-related problems in the future.

• Rest and Gradual Activity: After surgery, patients should allow for adequate rest, followed by a gradual increase in activity as outlined by the healthcare provider.
• Medication Adherence: Take all prescribed medications exactly as directed by the healthcare provider to manage pain and reduce the risk of complications, including antibiotics, pain relievers, or anticoagulants.
• Follow-up Appointments: Attend all scheduled appointments with the cardiac team to monitor recovery and heart function and ensure you are healing correctly.
• Lifestyle Adjustments: Make heart-healthy habits a permanent part of your lifestyle. This may include eating a well-balanced diet, quitting smoking, and managing diabetes or high blood pressure.
• Watch for Symptoms: Be on the lookout for symptoms of infection, irregular heart rhythm, or any other unusual or unexpected symptoms, and contact the healthcare provider immediately.

Depending on the unique characteristics of each patient, the intricacy of the procedure, and the existence of any underlying medical issues, the precise recovery and aftercare schedule may change. Recuperated patients must stick to suggested aftercare practices and maintain good communication with their healthcare professionals.

The benefits and risks associated with valvular tumor removal can be significant and should be carefully considered. 

Benefits of Valvular Tumor Removal:

• Relief From Symptoms: Surgery can alleviate symptoms such as breathlessness, chest pain, or fatigue, improving quality of life.
• Prevention of Complications: If left untreated, valvular tumors carry a significant risk of serious complications such as stroke, heart failure, or sudden cardiac death resulting from embolism or obstruction. Surgery can remove the tumor and prevent these complications from occurring.
• Restoration of Cardiac Function: Often, the normal function of the heart can be restored by removing the tumor and repairing the valve.
• Reduction in Embolic Risk: The risk of embolism, tumor fragments entering the bloodstream, and blocking vessels is significantly reduced after surgery.
• Improved Prognosis: With successful removal, most benign valvular tumors have excellent prognosis with a low chance of recurrence.

Risks of Valvular Tumor Removal:

• Surgical risks: As with any surgery, there is a risk of developing a surgical complication such as bleeding, infection, or an adverse reaction to anesthesia.
• Heart Rhythm Problems: Surgery can cause some patients to develop arrhythmias or abnormal heart rhythms that may require medication or placement of a pacemaker.
• Stripe dysfunction: Surgery may damage the mitral valve, making it work poorly. This would require a valve repair or replacement.
• Stroke: There is a small risk of stroke during surgery due to blood clots or debris dislodging and traveling to the brain.
• Recurrence: Recurrence of this tumor is infrequent. Most recurrences are because the tumor was not completely removed.

A cardiologist and cardiac surgeon should be consulted before deciding on surgery since they may offer specific information depending on the patient's condition.

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