Mitral Valve Procedures
For most patients, the procedure is needed due to mitral insufficiency (or a “leaky” valve). Mitral stenosis is also common. Mitral insufficiency is often caused by a childhood history of Rheumatic fever.
Mitral Insufficiency or Regurgitation
Mitral insufficiency occurs when the mitral valve does not close properly, causing blood to leak from the left ventricle, back through the mitral valve, and up into the left atrium. Mitral insufficiency most often occurs due to age (as a degenerative condition). Occasionally, the mitral valve is abnormal from birth as a congenital condition. More rarely, the mitral valve may be damaged by infection, known as infective endocarditis. Mitral insufficiency can also occur as a result of coronary artery disease.
Sign and Symptoms
The symptoms of mitral insufficiency vary, depending on the patient’s disease process. They are similar to the symptoms of congestive heart failure and can include:
- Shortness of breath
- Fluid accumulation in the lungs (pulmonary edema/pleural effusions)
- Severe night time shortness of breath and coughing, waking the patient from sleep (known as paroxysmal dyspnea)
- Decreased exercise tolerance
- Heart palpitations
- Cardiovascular collapse with shock
- A mid diastolilc murmur can be heard with a stethoscope.
- Patients with mitral insufficiency may also be asymptomatic. They may have the usual exercise tolerance, with no evidence of heart failure.
A number of different diagnostic tests may reveal mitral insufficiency, depending on whether the condition is chronic or acute. Tests used to diagnose mitral insufficiency include electrocardiograms (ECGs), echocardiograms, and chest X-rays. The most common diagnostic test is an echocardiogram and more specifically a transesophageal echo. This gives the closes look possible at the valve.
Surgical options to treat mitral insufficiency include mitral valve replacement and mitral valve repair, depending on the condition of the patient. Mitral valve repair is most preferred and often very doable.
Mitral valve replacement involves replacing the diseased mitral valve with a mechanical or bio-prosthetic, tissue, cow (bovine) or pig (porcine) valve. The traditional approach to repair/replace is via traditional sternotomy, however we offer a mini approach with use of Robot. The robotic approach involves 3-5 3” incisions on the right side of the chest. The surgeon may make the incision either horizontally under the left breast, or vertically through the sternum.
Bio-prosthetic replacement valves have a limited lifespan, usually ten to fifteen years, while synthetic replacement valves require the patients to use blood thinners in the long term, in order to reduce the risk of stroke.
A minimally invasive approach can result in less prominent scarring and frequently allows the patient to return to their normal activities faster. Providing a two weeks recovery time versus two months.
Indications for Operation
The need for surgery is typically indicated by severe mitral insufficiency, and the presence of symptoms of congestive heart failure. The diagnosis by echocardiography, without the presence of symptoms, can be enough to justify repair. Enlargement of the left atrium, especially when a recent onset of an irregular heartbeat (often atrial fibrillation) has been observed, is an indication for surgery. Recent data shows much greater benefit and lower risk operations if mitral insufficiency is corrected sooner rather than later.
When repair is possible, the probability of long-term success is good, with an 85 to 95% chance of no further procedures being required for approximately ten years. When more complex repair is required, the probability of further surgery goes up. Depending on the cause of the mitral insufficiency, it can be difficult to predict the results of repair.
With successful mitral valve replacement, the patient can expect to return to the same condition or better that they enjoyed prior to the surgery. Blood thinners are often prescribed for six weeks to three months after the operation. Commonly, this prescription is not required in the long term unless other indications are present. There are usually few restrictions on patient activity once surgical wounds have healed.