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Mitral Valve Repair
Mitral valve repair is an open heart procedure performed by cardiothoracic surgeons to treat stenosis (narrowing) or
regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood
flows from the lungs, where it picks up oxygen, and into the left atrium. When it opens, the mitral valve allows blood to
flow from the left atrium to the heart's main pumping chamber called the left ventricle. It then closes to keep blood
from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two
flaps, or leaflets.
The mitral valve is highlighted on this illustration of a heart. The mitral valve is the "inflow valve" for the left side of the
heart. Blood flows from the lungs, where it picks up oxygen, and into the left atrium. When it opens, the mitral valve
allows blood to flow from the atrium to the heart's main pumping chamber called
the left ventricle. (Click on the illustration to enlarge it.)
Occasionally, the mitral valve is abnormal from birth (congenital ). More often the
mitral valve becomes abnormal with age (degenerative) or as a result of
rheumatic fever. In rare instances the mitral valve can be destroyed by infection
or a bacterial endocarditis . Mitral regurgitation may also occur as a result of
ischemic heart disease (coronary artery disease) .
When it opens (left), the mitral valve allows blood to flow into the heart's main
pumping chamber called the left ventricle. It then closes (right) to keep blood from
leaking back into the lungs when the ventricle contracts (squeezes) to push blood
out to the body. It has two flaps, or leaflets. (Click on the illustration to enlarge it.)
Often the mitral valve is so damaged that it must be replaced (refer to Mitral
Valve Replacement) Occasionally, however, the valve can be repaired rather
than replaced. One type of repair is a procedure called mitral commisurotomy.
Mitral commisurotomy can be performed for some valves that are narrow or
"stenotic" either from birth or from damage by rheumatic fever. Most often
today, rheumatic mitral stenosis is treated by balloon valvuloplasty, a procedure
performed in the cardiac catheterization laboratory by interventional cardiologists. Using a catheter with a balloon on
the end, the balloon is expanded inside the valve "stretching" it open.
More often mitral valve repair is performed to correct a leaking or regurgitant valve. Congenital mitral regurgitation
may be due to a cleft mitral valve (a valve with a separation or cleft down the middle) associated with an atrial septal
defect, a type of hole in the heart between the low pressure chambers or atria. Such valves can sometimes be
repaired simply by closing the cleft with sutures. Valves regurgitant due to bacterial endocarditis can occasionally be
repaired, however the majority of mitral valve repairs are performed for degenerative disease. Degenerative mitral
valve disease may be due to an elongation or rupture of the chordal apparatus, the "heart-strings" that support the
valve normally, or due to a more generalized weakness of the valve itself such as the "floppy valve" syndrome in
which all of the components of the valve are enlarged and elongated.
Not all mitral valves can be repaired. A preoperative echocardiogram may help your surgeon predict the likelihood of
repair, but cannot guarantee it. Mitral valves that are regurgitant due to rheumatic fever are often both stenotic and
regurgitant, and are often beyond repair.
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Why Is Surgery Necessary?
The mitral valve is the inflow valve into the left side of the heart. It closes during systole (when the ventricle contracts
or squeezes blood out into the aorta and the rest of the body). When the mitral valve leaks, blood flows backwards
into the lungs. The ventricle must therefore pump more blood with each contraction to produce the same forward
output of blood throughout the body. This resulting condition is called a volume overload. The heart can compensate
for this volume overload for many months or years (provided the leakage came on slowly and progressively), but it
eventually begins to fail producing symptoms of shortness of breath or fatigue.
When Is Surgery Necessary?
The indications for mitral valve repair are undergoing constant reevaluation. Recent evidence suggests that earlier
surgical intervention, particularly if repair is possible, may prevent irreversible damage to the heart. The decision
regarding when to proceed with surgery should be made with your doctor. This decision will require judgement
regarding the risk of surgery and the benefits available from surgery. In some cases blood pressure medications,
such as ACE-inhibitors can significantly relieve symptoms.
Severe mitral regurgitation in the presence of symptoms of congestive heart failure is usually an indication for
surgery. Severe regurgitation diagnosed by echocardiography even without symptoms, may be sufficient to warrant
repair. Enlargement of the left atrium, particularly in the setting of the recent onset of an irregular heartbeat (atrial
fibrillation, premature atrial contractions etc.) is considered by many doctors also to be an indication for surgery.
What Are The Results Of Mitral Valve Repair?
The first thing to remember is that a surgeon can predict the likelihood of repair before surgery, but cannot guarantee
it. If repair is possible, the likelihood of long-term success is good, particularly for degenerative valve disease.
Depending upon the underlying abnormality there may be an 85 to 95% chance of needing nothing further done to
the valve over the next 10 years. If a more complex repair was required for degenerative disease, the chances of
long-term freedom from reintervention (further surgery) may be less. If a valve was damaged by rheumatic fever, the
disease may progress even after the repair, making the chances of the repair holding up in the long run less. Some
surgeons are, therefore, reluctant to repair rheumatic valves. The results of repair of mitral regurgitation associated
with coronary artery disease are the most difficult of all to predict.
What Will My Condition Be Like After Mitral Valve Replacement?
After successful mitral valve replacement you can expect to return to your preoperative condition or better.
Anticoagulation (blood thinners) with Coumadin is often prescribed for 6 weeks to 3 months postoperatively.
Generally this prescription is not required in the long term unless other indications for anticoagulation such as atrial
fibrillation are present. Once wounds have healed there should be few if any restrictions on a patient’s activity.
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936-441-1010•281-888-0809
[email protected]