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Learn About Mitral Valve Disease, Mitral Valve Surgery, and Other Treatment Options

When you are told of a problem with your mitral valve, it can be very confusing to understand the issue and your options.  It can also be frightening.  The questions you may be thinking about are: 1) Do I need surgery or not?, 2) What type of procedure should I have?, 3) Where should the procedure be done and who should do it?, 4) What are the risks of the various options?, 5) and can I be "cured"?  The purpose of this website is to explain what the mitral valve is, what it does, what can go wrong with it, what the options are for treatment, and expectations for outcomes of these treatments.  The good news is that there are many different options.  There are many different treatments including medication, minimally invasive surgery (such as endoscopic robotic mitral valve repair), traditional open surgery, and catheter-based options.  A big part of evaluating patients with mitral valve disease is determining if a procedure needs to be done and if so, what is the best procedure for the patient.

What is the mitral valve and what does it really do?

Mitral Valve Anatomy
Mitral Valve Anatomy

 The mitral valve sits between the left atrium and the left ventricle as seen the diagram to the left.  Blood returns from the lungs into the left atrium loaded with oxygen and ready to go out to the body.  The blood passes through the two leaflets of the mitral valve into the left ventricle.  The left ventricle then contracts and the mitral valve slams shut and and the aortic valve opens to allow this blood to go out to the body.  The mitral valve has two simple jobs: to open and close.  The normal mitral valve basically makes sure the blood keeps going in the right direction out to the body and not back towards the lungs.  With the next heartbeat, the mitral valve opens again and the process repeats itself.  In short, the normal valve keeps blood flowing in the right direction toward the body and away from the lungs.  The two leaflets do this by coming together when the heart contracts and closing the valve to prevent backward flow of blood.  When the heart relaxes the leaflets relax and open the valve and the process continues.  It is simple yet very important for normal heart function.   Problems can occur with any of the structures of the heart.

What can go wrong with the mitral valve?

Mitral Valve Regurgitation
Mitral Valve Regurgitation

The most common problem that can occur with the mitral valve is that it can leak blood backward into the left atrium (and toward the lungs) when the left ventricle contracts (squeezes).  This is called mitral regurgitation (or leaking) and is caused by various abnormalities of the valve.  One of the more common causes is mitral valve prolapse. The problem with blood going backwards is it increases the pressure of the blood on the left atrium (can cause atrial fibrillation or palpitations) and the lung (causing shortness of breath and pulmonary hypertension). Another problem that can happen with the mitral valve is that it can also become narrow or restrictive (mitral stenosis) which can also cause blood to back up into the atrium and lungs.  This often occurs because of damage to the leaflets from a condition called rheumatic disease (resulting from untreated strep throat years earlier).  Blood has trouble flowing through the small, narrowed valve to get to the left ventricle.

What can I do if I have a mitral valve condition?

Mitral Valve Repair
Mitral Valve Repair Example

Not all mitral valve conditions require a procedure (surgery or catheter-based).  However, a recent landmark study did conclude there was increased long-term survival and decreased heart failure with early surgical repair of mitral regurgitation due to mitral valve prolapse.  Some patients need no treatment at all (prolapse of the valve without regurgitation for example).  Some milder forms of regurgitation (leaking) or stenosis (narrowing) can be treated medically.  Although the decision to go ahead with a mitral valve procedure is complex and requires a thorough evaluation, most patients in reasonably good health with severe mitral valve disease should undergo a procedural intervention based on current recommendations from the American College of Cardiology and American Heart Association.  If surgery is required, we most often use totally endoscopic robotic approaches as this is the least invasive (smallest incision) way to treat this problem in my opinion.  Please see my other website, roboticheartsurgeon.com for more details on robotic approaches to the mitral valve.  Many patients don't need surgery at all.  For instance, most patients with "mitral valve prolapse" do not require surgery.  Also there are catheter-based options that are evolving as yet another option for the right patient.

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