Mitral Valve Disease

The human heart has four valves. Two left sided valves and two right sided valves. The mitral valve is the left sided valve that allows blood to pass into the pumping chamber from the lungs. There are two types of mitral valve disease. Mitral stenosis is when the valve is too small and narrow to allow adequate blood flow into the pumping chamber of the heart and pressure is put on the left atrium and the veins of the lungs. Mitral regurgitation is when the valve leaflets do not come together to close properly and blood is pushed backward toward the lungs.

Untreated rheumatic fever as a child can be a risk factor for mitral valve disease later in life. Sometimes a heart attack can result in mitral valve problems, but most often the cause of mitral valve disease is unknown. High blood pressure can also place pressure on the mitral valve causing dysfunction over time. Mitral valve regurgitation and stenosis usually occur slowly over time and there are degrees of severity of dysfunction.

Symptoms of mitral valve disease may include:

• Shortness of breath
• Swelling of the legs or feet
• Cough
• Fatigue
• Chest pain
• Dizziness

The first step to diagnosis is an evaluation by your doctor including medical and family history, physical exam, and risk factor evaluation. Some times your doctor may hear a murmur when listening to your heart with a stethoscope. No single test is used to evaluate mitral valve disease. Your doctor may order an electrocardiogram (EKG), chest x ray, or blood tests. Often an echocardiogram (ultrasound) of your heart is required to evaluate the mitral valve.

How is mitral valve disease treated?

The treatment may depend on whether your valve is leaky (regurgitation) or stenotic (too tight). There are degrees of both regurgitation and stenosis and if the dysfunction is not severe the best course may be close observation with an echo every 6 months to a year.

A mitral valve that has only mild or moderate dysfunction may not require any treatment if there are no symptoms. Medications cannot correct a faulty mitral valve, but they can help modify factors that exacerbate the valve. Some medications may be prescribed to address issues such as high blood pressure, elevated heart rate, or excess fluid in the body.

If the mitral valve is leaky there are two main options to address the valve leakage.

Surgical mitral valve repair works to repair the portion of the valve that is resulting in the trouble. Some times there are a combination of techniques to be employed such as chordal replacement, resection of redundant leaflet tissue or changing the leaflet height, or supporting the structure of the valve with a ring to prevent dilation of the valve. Some severely disease valves require replacement and your surgeon will talk with you about the options for mechanical or biologic valves.

Mitraclip is a minimally catheter based approach similar to placing a clothes pin in the middle of the valve to keep the valve leaflets from spreading too far apart. The valve itself is not repaired or replaced just the degree of potential leakage is addressed. The mitraclip procedure is often referred to by your cardiologist. Not everyone is a candidate for a mitra clip and sometimes there are reasons even older patients should undergo more traditional open surgery. This decision will be discussed with you and your heart team of cardiologists and surgeons.

Want to know more?
Here is a useful website: https://ctsurgerypatients.org/adult-heart-disease/mitral-valve-disease

On-X heart valve choices: https://www.heartvalvechoice.com/why-on-x/#:~:text=The%20On%2DX%20Mitral%20Heart,recommended%20by%20ACC%2FAHA%20Guidelines
https://www.cryolife.com/products/on-x-heart-valves/

Abbott Epic Mitral Valve https://www.structuralheart.abbott/products/mitral-aortic-valve-replacement/epic-tissue-valve?gclid=CjwKCAjw5dqgBhBNEiwA7PryaKBG6AgpKDPCseDlxX5xm48EZNzFnSr3X7iJN_s9pbC36O1OtgdMdRoC-RYQAvD_BwE

Abbott mitraclip https://www.cardiovascular.abbott/us/en/hcp/products/structural-heart/transcatheter-valve-solutions/mitraclip.html