The mitral valve plays a fundamental role in maintaining your overall health. Unfortunately, that means when the mitral valve succumbs to disease or injury, it can greatly impact your quality of life. If you've been diagnosed with a mitral valve issue and potentially need surgery, it's important to learn an overview of the procedure.
We spoke with Dr. Vu Hoang, a cardiothoracic surgeon at Saint Joseph Hospital, to learn about mitral valve repair. "The mitral valve is an important part of the heart that, when damaged or under attack from disease, can lead to long-term negative health effects if not properly diagnosed and treated," says Dr. Hoang.
What is the mitral valve?
The human heart is a vital organ responsible for pumping blood throughout the body, ensuring oxygen and nutrients reach various tissues and organs. It is divided into four chambers: two atria (upper chambers) and two ventricles (lower chambers). The heart's left side pumps oxygenated blood to the rest of the body.
The mitral valve is a crucial component of the heart, located between the left atrium and left ventricle. It acts as a one-way gate that controls the flow of blood from the atrium to the ventricle. During each heartbeat, the mitral valve opens to allow blood to pass through. Once filled, the valve closes to prevent blood from flowing backward, ensuring a unidirectional flow.
"If the mitral valve disease is mild, your health care provider may first suggest regular checkups to monitor your heart health," says Dr. Hoang. "You may be prescribed medication to manage symptoms, rather than surgery."
Various conditions can affect the mitral valve, leading to dysfunction. Common problems include mitral valve regurgitation (leakage of blood backward into the atrium) and mitral valve stenosis (narrowing of the valve opening). These issues can result from congenital defects, infections, or age-related degeneration, impacting the valve's ability to function properly and necessitating medical intervention, including mitral valve repair.
What are the signs and symptoms of mitral valve issues?
The signs and symptoms of mitral valve issues can vary depending on the specific problem. Individuals experiencing problems with their mitral valve may notice the following:
- Shortness of breath: Abnormal difficulty breathing or shortness of breath, especially during physical activity or when lying down, can be a sign of mitral valve issues. This is often due to blood not flowing efficiently through the heart.
- Fatigue: Feeling unusually tired or fatigued, even with minimal physical exertion. Inefficient blood circulation can impact the delivery of oxygen and nutrients to the body's tissues.
- Heart palpitations: Irregular or rapid heartbeats, commonly known as palpitations, may occur. This can be a result of the heart working harder to compensate for mitral valve dysfunction.
- Swelling: Fluid retention and swelling, particularly in the legs and ankles, may occur due to the compromised ability of the heart to pump blood effectively.
It's crucial to seek medical attention if any of these symptoms are present or if there are concerns about heart health. Mitral valve issues, if left untreated, can lead to more severe complications and negatively impact overall heart function. A health care professional can conduct diagnostic tests to identify the specific problem and recommend an appropriate course of action, which may include mitral valve repair.
What is the difference between mitral valve repair and replacement?
While the two procedures may sound similar, mitral valve repair and mitral valve replacement are two different surgeries. The decision for which one is best for a patient depends on the severity and nature of the issue. Both procedures aim to restore the proper functioning of the mitral valve, but they differ in their approaches
Mitral Valve Repair
Mitral valve repair involves fixing the existing valve, preserving its natural structure as much as possible. There are also different techniques for repair, such as stitching together torn valve leaflets, reinforcing the valve with a ring, or removing excess tissue.
A repair is often preferred when feasible as it preserves the patient's own valve, potentially leading to better long-term outcomes and a lower risk of complications.
Mitral Valve Replacement
Replacement involves removing the damaged or dysfunctional valve and replacing it with a prosthetic (artificial) valve. Prosthetic valves can be mechanical (made of durable materials) or biological (made from animal or human tissue). The choice depends on factors such as age, lifestyle, and the patient's overall health.
Replacement is considered when the mitral valve damage is extensive and cannot be effectively repaired. While it provides a new valve, it also comes with the need for lifelong anticoagulant medication in the case of mechanical valves, among other concerns.
"One of the negatives of a mitral valve replacement is that patients will need to be on blood thinners for life to prevent blood clots. Also, biological tissue valves break down over time and will most likely need to be replaced," says Dr. Hoang.
Overview of the Mitral Valve Repair procedure
Because every patient is different, some specific parts of a mitral valve repair differ. The specific steps involved can also vary based on the nature and extent of the valve damage, but there are some general steps that most patients can expect.
Patients undergo a thorough preoperative evaluation to assess their overall health and suitability for surgery. The surgical team discusses the procedure, potential risks, and benefits with the patient.
At the beginning of the surgery, the patient is administered general anesthesia to ensure they are unconscious and pain-free during the surgery. A surgical incision is made, typically in the chest, to access the heart. The choice of incision may vary, and minimally invasive techniques may be used in some cases.
The patient is connected to a heart-lung machine which takes over the functions of the heart and lungs. This allows the surgeon to stop the heart temporarily for the repair. The surgeon then exposes the mitral valve by opening the heart's chambers. This provides direct access to the damaged valve.
"Many patients might undergo minimally invasive procedures that use robots to make small incisions that leave small scars rather than large ones," says Dr. Hoang.
Depending on the specific issues, the surgeon employs various repair techniques. These may include:
- Stitching torn valve leaflets.
- Reinforcing the valve with a ring or annuloplasty.
- Reshaping or resecting excess tissue.
- Addressing issues with the chordae tendineae.
After the repair is completed, the surgeon closes the incisions in the heart and chest. The patient is then gradually weaned off the heart-lung machine, and the heart resumes its normal function.
Once stable, the patient is moved to the intensive care unit (ICU) for further monitoring. The recovery process may involve hospitalization for a few days to ensure a smooth recovery.
