Surgeons at the Heart and Brain hospital in Burgas have replaced the mitral valve of an 85-year-old man from Varna, local media reported. Instead of a mitral valve, they used a valve made for the aortic position, turned it around and modified it. They fitted it endoscopically through a cut of about 3 cm in the chest.
Local media say no one in the world has done such an operation before. The valve's maker confirmed it has no record of the same procedure in this combination: an old aortic prosthesis, a badly damaged mitral valve and a similarly modified implant placed endoscopically.
The patient has two separate heart conditions. Five years ago, another hospital fitted him with a transcatheter aortic prosthesis, an artificial valve in place of the aortic one. He also has severe mitral stenosis, a narrowing of the valve between the left atrium and the left ventricle.
His condition worsened gradually. Tests in Burgas showed that the old aortic prosthesis leaked and did not work. The mitral valve was badly narrowed because its ring and leaflets had calcified, meaning chalky deposits had built up in them.
Doctors said the heavily calcified tissue and the old implant made the case harder. Fitting a mitral valve through a catheter, the standard method, carries a very high risk. It can block the flow of blood out of the heart, which can lead to death.
A team of interventional cardiologists and cardiac surgeons planned the treatment. After precise measurements and complex calculations, they decided the usual approach could not be used in this case.
Dr Petar Uzov, head of the hospital's cardiac surgery department, proposed the solution. He led the team and carried out the operation. The doctors took a transcatheter valve designed for the aortic position, turned it around and changed its design. They then fitted it surgically in place of the mitral valve.
"I had enough courage to modify it," Dr Uzov said of his decision to change the valve.
Local media say the hardest part was deciding exactly how to modify the valve. It had to fit the anatomy of this patient and not block the flow of blood out of the heart.
The treatment took place in two stages, a month apart. In the first, the doctors placed a new valve inside the old aortic prosthesis, which no longer worked.
Dr Petar Iliev took part in this stage. The hospital describes him as one of the leading specialists in interventional cardiology, endovascular treatment, pacing and echocardiography. He assessed the limits set by the patient's anatomy and whether the new valve could be placed without disrupting blood flow.
The second stage was a fully endoscopic operation. The surgeons worked with a camera and instruments inserted through the small cut in the chest, without opening the breastbone wide. During the operation the heart was stopped and a machine kept the blood circulating.
The team carried out steps planned in advance, in exact order, including modifying and fitting the valve. The procedure was a success, local media reported. Doctors say the combination of a non-standard implant and endoscopic access makes the operation very complex.
The patient turned 85 while in hospital. He was discharged a week after the operation. According to local media, he left with no complaints and a chance of a good quality of life.
After the operation, the team gave the valve's maker a detailed account of how the implant was done. The check also included the medical database.
Local media say Dr Uzov is among the few doctors with the experience and routine for such operations. They call him one of the pioneers of fully endoscopic heart surgery in Bulgaria. In 2019 he was the first in the country to introduce this type of operation, and that same year he won the national award for innovation in medicine.
The surgeon has hundreds of endoscopic operations behind him. He did many of them during his training in Italy, Germany and China.
Local media believe the case shows how surgical experience, precise calculations and an individual approach to each patient can provide a solution when standard methods do not help. They also named trust between doctor and patient as a condition for such treatment.