September 26, 2017

Mitral Valve Surgery

Mitral valve surgery is performed by heart surgeons to treat mitral valve disease, mitral valve stenosis, and mitral valve regurgitation.

What is the mitral valve?

The mitral valve is located between the two chambers on the left side of the heart. The function of valves is to maintain one-way blood flow through the heart.

What is mitral valve disease?

Examples of when the mitral valve does not work are:
Mitral valve stenosis: Stiff, fused, inflexible valves lead to the narrowing of the mitral valve which limits or blocks the blood flow. It has been found that the main cause of mitral valve stenosis is a childhood infection called rheumatic fever, which is related to strep infections.  Early rheumatic fever infections can scar the mitral valve and cause serious heart complications.

Mitral valve regurgitation: Also called mitral insufficiency or mitral incompetence. This happens when the heart’s mitral valve does not close tightly enough and allows blood to flow backwards in your heart. This causes the heart to not move blood through the rest of your heart/body as efficiently.

Causes of mitral valve regurgitation can include:

  • Mitral valve prolapse: defect that prevents the valve from closing tightly
  • Damaged tissue cords: tears in these cords can cause leakage in the valve
  • Rheumatic fever
  • Endocarditis: an infection in the lining of the heart
  • Wear and tear on the valve:  normal aging wearing of the valve
  • Prior heart attacks
  • Untreated high blood pressure
  • Congenital heart defects: born with defects in the heart

What are the symptoms of mitral valve disease?

Initial symptoms of mitral valve disease usually include:

  • Tiredness
  • Short of breath
  • Heart palpitations – feeling rapid fluttery heartbeat
  • Swollen feet or ankles
  • Feeling of lightheadedness
  • Coughing, especially at night or lying down

How is mitral valve disease diagnosed?

The diagnosis of mitral valve disease is made after your physician performs a physical exam, reviews the symptoms and evaluates the results of diagnostic tests. During your physical exam, the doctor will first listen to your heart with a stethoscope. Using a stethoscope, he may hear a murmur, which represents turbulent blood flow across an abnormal valve.

Other commonly used tests include:

  • Chest X-ray
  • Echocardiogram
  • Electrocardiogram (ECG)
  • Transesophageal echocardiogram
  • Exercise test
  • Cardiac catheterization

Mitral Valve Repair versus Mitral Valve Replacement

Mitral Valve Repair

Mitral valve repair is surgery on the existing valve. When possible, a leaking mitral valve is repaired rather than replaced. The leakage of a valve is problematic because it is not closing completely. When a valve does not close completely, it allows blood to flow backwards, which in turn causes blood to back up in the heart and body. The root cause of problems can be traced to either loose valves (floppy), or dysfunctional muscles in the heart that pull the valves closed.

Mitral Valve Replacement

If the existing valve cannot be repaired due to damage or advanced disease, it must be replaced with an artificial valve. Often times, valves damaged by rheumatic disease must be replaced. There are two options of artificial valves: mechanical and biological valves.

Mechanical Valves: are synthetic or made of metallic alloy and pryolytic carbon

Biological Valves: are made of animal tissue, valves usually taken from pig or cow tissue.

The choice between mechanical or biological valves will depend on age, lifestyle, patient preference, and any other existing medical conditions.

How is a mitral valve replacement done?

Goals of Mitral Valve Surgery:

  • Improving quality of life
  • Improving heart function
  • Increasing long-term survival
  • Lower risks of stroke