The mitral valve is essentially the gateway between the left atrium and left ventricle chambers of the heart. It is a two part flap that opens and closes allowing blood to flow to the left ventricle. In some cases, problems with the mitral valve including conditions like mitral valve stenosis, mitral regurgitation, infective endocartis and mitral valve prolapse can lead to the need to various types of treatment techniques for this part of the heart. Many times, surgery for mitral valve repair is indicated.
Mitral regurgitation is a condition that is also known as mitral incompetence and mitral insufficiency. These names are appropriate because the condition refers to the valvee not opening and closing properly. Mitral regurgitation is most often caused by mitral valve prolapse, a condition where the valve itself becomes thickened or displaced. Complications from the valve disorder can lead to the signs of congestive heart failure, including problems with both the respiratory and cardiac systems.
Surgical mitral valve repair may be indicated in these instances because of heart valve leakage. When stenosis (narrowing) or regurgitation is present, it is possible that blood may actually flow backwards and thus leak from the destination left ventricle in the wrong direction, through the leaking heart valve, and into the left atrium. This can lead to alarming symptoms like finding blood in phlegm and difficulty breathing.
Treatment for irregularities in the mitral valve greatly depends on the symptoms that present. Many times, medicines are more than adequate to control the symptoms of problems of the mitral valve. For instance, many times mitral stenosis symptoms are not severe enough to warrant treatment or surgery. However, when heart dysfunction is evident or symptoms persist such as coughing up blood or, pulmonary edema, dyspnea and heart palpitations, mitral valve repair or replacement may be suggested.
The most common and least invasive type of surgery for the mitral valve is a procedure known as a balloon valvotomy. It is commonly used to treat mitral valve stenosis. During the procedure, a very thin tube is placed through an artery from an insertion point in the arm or the groin and fed from there up into the heart. Once the thin tube has made its way to the mitral valve, a balloon that is on the end of the tube is rapidly inflated which can stretch the opening of the valve and thus make the opening bigger so that more blood can move through the heart. Because this type of mitral valve repair is not open heart surgery, recovery time is greatly reduced and there are less serious risks. The surgery is usually indicated for people with mild symptoms or those who are asymptomatic.
Although a less serious type of procedure, there are some complications to consider. First of all, this type of procedure is not appropriate for cases of mitral valve regurgitation. Additionally, there is no guarantee that the results are permanent, and it is not uncommon for valves to again narrow after a period of one to two decades. Further, those with blood clots or calcifications are likely not good candidates for this procedure. The vast majority of the time, this type of mitral valve repair is very successful and complications are minimal. However, it is not unheard of for mitral valve regurgitation or other complications to arise following a balloon valvotomy.
Sometimes, when the valvotomy is not a suitable option, the mitral valve may need to be repaired via open heart surgery. This is a very serious procedure, and the heart must be stopped in order for the surgery to take place. People undergoing heart surgeries of this type are placed on a device called as a heart lung machine in order to stay alive during the procedure. Once doctors are inside, the necessary repairs are made to the valve. This type of surgery has the longest recovery time, with weeks to months not being unheard of. Further, the increased risk of complications from infections and bleeding are greatly increased in open heart surgery. There are less invasive methods of this type of procedure; however they are not practical in all cases.
Sometimes, mitral valve repair is not possible, and the valve needs replaced. In a mitral valve replacement, a durable replacement for a severely damaged valve may be used and inserted during surgery. Sometime, mechanical valves are used in these procedures and they are associated with a much greater risk of developing blood clots, thus the use of anticoagulant medication often follows.
The type of mitral valve repair indicated for each person will depend on his or her health, the severity of their condition and the risks associated with each type of procedure. Sometimes procedures are even combined for the best outcome. Regardless, an individually tailored approach that takes into account family history, symptoms and risk is a discussion that will need to be had between a doctor and a patient.