Mitral Valve – Repair, Replacement, Surgery

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mitral-valve-stenosis-narrowing-of-mitral-valveMitral valve, also referred to as the bicuspid valve, controls blood flow that is flowing into the heart. When functioning normally, pressure from the left atrium causes the mitral valve to open as blood flows into the left ventricle. The mitral valve then closes, preventing blood from flowing back into the left atrium so it can continue to be pumped through the heart. When the mitral valve closes, the cessation of blood flow produces the first heart sound. Upon the mitral valve opening a sound is not normally heard with the exception of mitral valve disease present.

Mitral valve leakage Symptoms
Mitral valve leakage can attribute to the following symptoms:

  • Shortness of breath
  • Chest pain
  • Heart palpitations
  • Extreme fatigue
  • Coughing
  • Rapid heartbeat (although fairly uncommon)

Mitral Valve Disease

There are three different forms of mitral valve disease: mitral valve prolapse, mitral valve regurgitation, and mitral valve stenosis.

 

Mitral valve prolapse occurs when the valve flap becomes enlarged. This prevents the mitral valve from closing evenly and therefore prevents optimal blood flow. This mitral valve disorder can be identified by use of a stethoscope. It is characterized by a clicking sound followed by a heart murmur.

Another mitral valve disease is known as mitral regurgitation, which is damage caused to the mitral valve due to a heartattack or heart infection. Symptoms are similar to that of mitral valve prolapse and both are more commonly treated with antibiotic medicine than by use of mitral valve surgery. Your doctor should know whether or not the condition is serious enough to undergo mitral valve replacement for either mitral valve prolapse or mitral regurgitation.

Mitral valve stenosis is definitely a more serious condition of the three mentioned. Although it is usually caused by rheumatic fever, mitral valve stenosis can be caused by any condition that causes the mitral valveto become narrow. With older individuals, calcium may begin to build up around the valve where the mitral valve and heart muscle meet. Mitral valve stenosis is less common in developed countries that have medicine to prevent this mitral valve disease, though it is still a threat that exists and should be monitored through regular check-ups.

Mitral valve stenosis symptoms include:

  • Shortness of breath and night or following exercise
  • Coughing, which in some cases can produce a pink, blood-tinged phlegm
  • Fatigue
  • Chest pains that worsen during physical exertion, not as noticeable during rest
  • Frequent respiratory infections including but not limited to bronchitis
  • Heart palpitations (feeling that the heart skipped a beat)
  • Swelling of the feet and ankles
  • Voice becoming hoarse

Any mitral valve disease can become quite serious if left untreated. Prolonged mitral valve leakage can eventually lead to heart failure or stroke. Blood clots can also develop in various parts of the body due to a leaky mitral valve. It’s best to consult a doctor in regards to whether or not you are in need of mitral valve surgery. It may be necessary in some cases to undergo mitral valve repair or mitral valve replacement.

If that’s the case and a mitral valve disorder poses a threat to one’s life span and cannot be treated with medicine, mitral valve surgery is likely necessary.

Mitral Valve Repair

Mitral valve repair is usually related to congenital valve defects (complications you are born with). There are about six different procedures surgeons use depending on how the mitral valve is defective. These include:

Commissurotomy, which is used when the mitral valve is too narrow. The leaflets are too wide and they could be obstructed. The surgeon opens up the mitral valve by cutting the points where the leaflets are stuck together.

Valvuloplasty, which strengthens weakened leaflets to provide support and allows them to close the mitral valve tightly. This is done by using a ring-like device that is attached around the outside of the mitral valve.

Reshaping, this is when the surgeon cuts out a section of the leaflet, and sews it back together. Pretty self explanatory.

Decalcification, the removal of calcium buildup from the leaflets, allowing them to close properly and prevent a leaky mitral valve.

Repair of structural support. Cords that give the mitral valve support are shaped to the right length, allowing the mitral valve to close properly.

Patching, where holes in the leaflets are patched to prevent mitral valve leakage.

Mitral Valve Replacement

mitral-valve-surgery-with-mechanical-valveIn more severe cases, especially when mitral valve leakage is extreme and the seriousness of mitral valve disease is life-threatening, mitral valve replacement may be essential. There are two different options for mitral valve replacement: mechanical and biological.

 

Mechanical mitral valves, which are typically made from materials such as carbon, metal, or plastic, are built strong and made to last longer than their biological counterparts. However, blood tends to clot around mechanical mitral valves, and patients will be required to take blood-thinning medicines (anticoagulants) for the rest of their lives once the mitral valve replacement is completed.

The other option for mitral valve replacement is biological mitral valves. These are taken from an animal tissue, or alternatively taken from the human tissue of a donated heart. In some cases, the mitral valve replacement can be performed using a patient’s own tissue if there is enough to spare. The advantage of having a biological mitral valve replacement is that patients don’t commonly have to take anticoagulants. However, biological mitral valves usually have the life span of about 10 years before they need to be replaced, and need to be replaced even more frequently in children and young adults.

That being said, it’s a good idea to discuss with a doctor to decide which mitral valve replacement method is best.

Mitral Valve Surgery

If diagnosed with mitral valve stenosis, and mitral valve surgery is a viable option for treatment, there are certain preparations that should be taken before the date of surgery. A patient needs to make sure he/she practice good hygiene up to the surgery date. This is to reduce the amount of germs on your skin. Also be sure to go in on an empty stomach, otherwise the anesthetic the surgeon administers could cause complications.

 

On the day of mitral valve surgery, there will likely be a series of tests. These can include blood/urine tests and a chest x-ray to provide the surgeon with updated information on the patient’s health. Lastly, electrodes will be attached to the chest which monitor the hearts rhythm and electrical activity. Once that’s done, the anesthetic is applied intravenously, and the mitral valve surgery is under way. This usually takes two to four hours, the patient is completely asleep and won’t feel a thing.

Once the mitral valve surgery is completed, patients usually spend between one and three days in ICU (intensive care unit). Following mitral valve surgery, it’s best to limit physical exertion. Those working office jobs typically are able to return in 4-6 weeks; those who work more physically demanding jobs may need to wait longer before they can go back.

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