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Published on August 23, 2022

Evaluating and Treating Mitral Valve Disease

Mitral Valve

The mitral valve is one of four valves in your heart. Each valve has a leaflet or flap that opens and closes with every heartbeat. If the opening or closing doesn’t happen properly, it results in mitral valve disease, which can affect blood flow through the heart to the body.

There are two types of mitral valve disease. Valve regurgitation (commonly called a leaky valve) is a backward flow of blood through the mitral valve, and occurs when the leaflets don’t form a seal, allowing blood to swish backward (called a leak) into the heart’s left atrium rather than flowing forward. There are a variety of causes for mitral valve regurgitation.

Valve stenosis, on the other hand, occurs when the leaflets of the mitral valve stiffen, thicken or fuse together. This causes the valve to narrow, preventing it from fully opening and resulting in restricted blood flow through the valve and stagnation of blood in the left atrium.

While mitral valve disease can be serious if left untreated, there are many people with mitral valve disease that have NO symptoms for many years. Symptoms can include shortness of breath, especially when lying down or exercising, fatigue/tiredness, irregular or fast heartbeat, lightheadedness or fainting, dry, hacking cough, pain or tightness in the chest, swollen feet or ankles and a decrease in appetite. It takes a long time for patients with mitral valve disease to develop symptoms but once that happens, the patient can deteriorate very quickly and time is of the essence.

If you’re experiencing any of the symptoms listed above, the best thing to do is talk to your primary care provider and seek expeditious referral to a cardiologist if a mitral valve problem is suspected. A cardiologist will use a variety of diagnostic tests to determine whether or not you have mitral valve disease, including an echocardiogram, a chest X-ray, a transesophageal echocardiogram or a cardiac catheterization.

For those diagnosed with mitral valve disease, there are various treatment options. Depending on the severity and specific cause for the mitral disease, options include medical management, catheter-based procedures, pacemakers or heart surgery. A significant number of patients will also have disturbance in heart rhythm called atrial fibrillation and this may have to be treated along with the mitral valve problem.

When heart surgery is used to correct mitral valve disease, there are two options. With the first option called minimally-invasive mitral valve surgery, a heart surgeon repairs the mitral valve using a tiny incision between the ribs on the patient’s right side. The breast bone is left intact and not cracked open. Repairs are generally preferred and usually the first choice offered to our patients since a patient gets to keep their own valve which would continue to last for a long time. In some cases, a replacement of the valve will be done through the same incision using an artificial valve or pig/cow valve. The other option is to perform heart surgery by fully cracking the breast bone (sternotomy). At our facility, the majority of mitral valve surgery is performed without cracking the breast bone and patients recover much faster than traditional heart surgery.

Catheter-based options called “clipping” are used for some patients. A needle puncture in the groin is used to guide a catheter into the heart through which a clip is placed across the mitral valve to decrease mitral regurgitation by bringing the edges of the flaps of the mitral valve together, allowing blood to flow on both sides while decreasing leakage. For those patients with a weak heart or those who cannot tolerate heart surgery, catheter-based mitral clipping is our preferred choice.

These procedures are designed to shorten a patient’s recovery time and hospital stay. More importantly, many patients have a severely leaking mitral valve with no symptoms and these patients benefit the most with early intervention before any symptoms develop. Overall, it’s best to identify mitral valve disease early and treat it well before symptoms begins to impact quality of life or progresses to congestive heart failure, atrial fibrillation or pulmonary hypertension.

Raj Gopaldas, M.D., is a cardiothoracic surgeon at MyMichigan Health.