Mitral Valve Repair for Severe Regurgitation

Mitral Valve Repair for Severe Regurgitation

Mitral Valve Repair in Mr. Sandeep Bahirwani, a 51-Year-Old Patient with Severe Regurgitation Due to a Myxomatous Valve
Surgeon: Dr. Vishal Khullar, Director, Cardiothoracic & Vascular Surgery, Heart and Lung Transplant
 Hospital: Nanavati Max Super Speciality Hospital, Vile Parle West, Mumbai
 Procedure: Mitral Valve Repair for Severe Mitral Regurgitation
 Video Testimonial: Four-part patient journey, linked in the Patient Testimonial Videos section

Patient details below have been recorded in line with confidentiality conventions for written case studies. Mr. Bahirwani and his family have separately provided consent for the on-camera testimonials referenced in this document.

Condition

Mr. Bahirwani was diagnosed with mitral valve prolapse in 2019 and, over the following years, developed severe mitral regurgitation, meaning the valve was leaking significantly and no longer closing properly with each heartbeat. Symptoms began with leg swelling and progressed to shortness of breath, both signs that the leaking valve was placing a growing strain on the heart. Every specialist he consulted, in Mumbai and abroad, reached the same conclusion, that the valve needed valve repair or replacement.

Impact on the Patient

At 51, Mr. Bahirwani was younger than the typical age for a tissue valve, generally recommended above 65 due to its limited lifespan, while a mechanical valve would have meant lifelong blood-thinning medication, a commitment he was reluctant to accept. He had also been offered the MitraClip procedure, but this was not considered the right choice for him. Despite consistent advice that surgery was necessary, he had not found a surgeon he felt confident proceeding with, until he consulted Dr. Vishal Khullar, a leading cardiac surgeon in Mumbai. His hesitation reflects a common concern around surgery timing for mitral valve prolapse.

What Was Assessed During the Consultation

• History of mitral valve prolapse since 2019 and the progression of symptoms
• Detailed echocardiographic review of the valve leaflets and severity of regurgitation
• Suitability for the MitraClip procedure versus surgical treatment
• Age-appropriate assessment of tissue valve versus mechanical valve replacement
• Anatomical suitability of the valve for repair rather than replacement

Why This Surgical Approach Was Chosen

• The MitraClip procedure, in which a cardiologist deploys a clip through a leg vein to bring the valve leaflets together, was assessed and ruled out in favour of definitive mitral valve repair, since MitraClip is not an anatomical repair and can lead to mitral stenosis over time in a younger patient
• A tissue valve, generally suited to patients above 65, would likely have degenerated well within Mr. Bahirwani’s remaining lifespan
• A mechanical valve would have meant lifelong anticoagulation, a prospect the patient did not want
• Careful review of the echocardiogram confirmed the valve was myxomatous in nature, a leaflet pathology that, depending on its anatomy, can often be repaired rather than replaced
• The strategy was built around restoring valve function while avoiding both the durability limits of a tissue valve and the anticoagulation burden of a mechanical one
• The final decision was made jointly with the patient, guided by the surgical assessment of Vishal Khullar and the anatomy observed during consultation

Pre-operative documentation included transthoracic echocardiography to characterise the leaflet pathology and the severity of regurgitation, review of prior reports obtained during earlier consultations, and the standard cardiac surgical workup. Imaging confirmed the valve was suitable for a repair-first strategy rather than replacement.

Step-by-Step Surgical Overview

1. Patient transferred to theatre with full monitoring established, general anaesthesia administered
2. Median sternotomy performed and the mitral valve exposed
3. Cardiopulmonary bypass instituted to allow work on a still, empty heart
4. Direct inspection confirmed a myxomatous leaflet pathology suitable for repair
5. Mitral valve repair carried out, using the technique indicated by the leaflet anatomy, including triangular or quadrangular resection of the posterior leaflet, sliding or ring annuloplasty, or artificial cord replacement
6. On-table echocardiogram confirmed competent valve function with no residual leak
7. Patient weaned off bypass and the chest closed in layered fashion

Whether a mitral valve can be repaired depends on the underlying pathology, whether myxomatous, degenerative, or rheumatic, and on the anatomy of the leaflets and their scallops. In Mr. Bahirwani’s case, the anatomy allowed a full repair, avoiding the need for a prosthetic valve altogether. This repair-first approach reflects Dr. Khullar’s experience across a wide range of cardiac treatments, built over years of surgical training.

Procedure Facts

Recovery progressed in line with the surgical plan. Mr. Bahirwani did well after surgery, with no complications recorded, and both he and his family describe the recovery as steady and complete.

Outcomes at a Glance

Mr. Bahirwani, his mother, and Dr. Vishal Khullar each shared their perspective on the diagnosis, decision, and outcome across a four-part video series published on the surgeon’s official YouTube channel.

Recorded across a four-part video series. Quotations reflect Mr. Bahirwani’s and his mother’s own words.

“I have been diagnosed with mitral valve prolapse in 2019, and it has been a tough journey. I had shown my reports to various doctors in Mumbai and abroad, but the only solution was repair or replacement. I was not confident in any of the doctors until I met Dr. Vishal, and he explained the treatment to me very well. I am recovering quite well now.”

Patient: Mr. Sandeep Bahirwani · Male · 51 years
 Procedure: Mitral Valve Repair · Nanavati Max Super Speciality Hospital, Mumbai
 Surgeon: Dr. Vishal Khullar · Director, Cardiothoracic & Vascular Surgery, Heart and Lung Transplant

“I think he is one of the best cardiac surgeons in Bombay. My son was not ready to go through the surgery at first, but when we met Dr. Khullar, he explained everything meaningfully, and then the decision was taken. The operation was a success. I would advise anyone with the same problem to at least go for a second opinion with him.”

Relation: Mr. Bahirwani’s mother

Recovery after mitral valve repair follows the same general principles as recovery from any open-heart procedure. A broader overview of what to expect is available in the guide on heart surgery recovery.

Instructions Provided to the Patient

• Cardiac medications continued exactly as prescribed
• Sternal precautions avoiding heavy lifting or strain for around six to eight weeks
• Graded activity protocol with gradual return to routine, supported by cardiac rehabilitation where appropriate
• Wound care and monitoring for signs of infection
• Structured follow-up appointments with echocardiography to confirm the repaired valve is functioning well

Recovery Timeline