More About Mitral Valve Procedures
Mitral Valve Pathology
When the mitral valve does not function properly, it can cause excessive leakage of blood back into the left atrium. In its most severe form, it can cause blood to back up into the lungs and cause deterioration of heart function. Together, these conditions are called congestive heart failure.
Leakage of the mitral valve, called mitral valve regurgitation, can be produced by a number of different pathologic conditions. Most commonly, excessive leaflet tissue prevents the leaflets from closing normally, leading to leakage of blood through the valve. Alternatively, the muscles or chordae that support the leaflets can rupture, which prevents normal valve closure. Finally, different adaptations to chronic heart failure can cause the annulus of the mitral valve to enlarge, thereby producing leakage.
Less commonly, other factors can prevent the mitral valve from opening enough, actually restricting the amount of blood that can flow through the valve. This condition, usually associated with rheumatic fever, is called mitral valve stenosis.
Mitral Valve Treatments
Mitral valve regurgitation can be successfully treated with surgery, and, if performed early enough, can limit progression of congestive heart failure. If you have mitral valve regurgitation, your cardiologist should discuss the various treatments available to you, including medical therapy as well as surgery. There are two surgical options for treatment for mitral valve regurgitation -- mitral valve repair and mitral valve replacement.
Mitral Valve Repair
While initially, most valves had to be replaced, the mitral valve can now be successfully repaired in over 90% of patients with mitral valve regurgitation. Mitral valve repair has significant advantages over replacement, as it is associated with better long term outcomes and less need for future surgery. Repair techniques are varied, but generally involve reconstructing the patient's own valvular tissue to produce better coaptation of the valve leaflets. Additionally, a ring or band is placed in the mitral annulus, which provides structural support for the repaired valve.
Mitral valve repair can now be performed using small incisions in the chest, avoiding the need for a sternotomy. Using some specialized instruments, the mitral valve can be repaired using the exact same techniques that are used in the standard approach. Using these less invasive techniques, patients may experience less pain and may return to their normal activities sooner.
Mitral Valve Replacement
Early in the history of mitral valve surgery, replacement of the valve was the most commonly performed treatment. It is still performed today, and the valve replacements fall into two general categories, mechanical valves and bioprosthetic ("tissue") valves. While mechanical valves have a long lifespan, patients will need to be treated with blood-thinners (i.e. coumadin) for the rest of their lives. Bioprosthetic valves can last 10-15 years, but patients do not need any treatment with blood-thinners. Mitral valve replacement surgery is generally indicated in those patients with advanced rheumatic valvular disease or significantly calcified valves, for whom mitral valve repair surgery is not possible.
Make an appointment at one of our Westchester Heart & Vascular locations. For physician information or to find a physician, call (866) WMC-HEART (866-962-4327).