Heart Valve Q & A
By Dr. Neal D. Kon
What is mitral valve disease?
The mitral valve is located between the heart’s left upper (holding) chamber or atrium, and left lower (pumping) chamber or ventricle. Heart valves have flaps called leaflets that are constantly opening and closing, letting blood move around the four chambers of the heart.
When a heart valve is not working properly – whether due to a congenital defect or damage by disease – a person may have fatigue, shortness of breath, chest pain, palpitations, or other symptoms.
In some cases, calcium deposits build up around the valve and cause the space to narrow, which means that blood cannot flow properly into the pumping chamber and out to the body. Another problem occurs when the valve does not close properly, allowing blood to leak back up into the atrium. In either case, the heart is not working properly.
Each year about five million people in this country are diagnosed with heart valve disease. It is quite common.
How do you diagnose mitral valve disease?
Your cardiologist will begin by giving the patient an exam and listening to the patient’s heart to hear how the valves open and close and the blood flows. If the cardiologist hears a heart murmur on exam or the patient’s symptoms warrant it, he will order a surface echocardiogram to target the problem. A probe is placed on the patient’s chest and pictures are taken of the heart chambers and valves.
Another test is the transesophageal echocardiography (TEE) and involves placing a probe into the esophagus. This positions the probe closer to the heart so that a more accurate look at the extent of the valve disease can be determined. The cardiologist can also use TEE during surgery to look at the valve right before the operation and after to assess the work done by the surgeon.
Does the valve have to be repaired or replaced?
Your doctor will discuss with you the right treatment for your condition. In some cases, medication such as anticoagulants can help. Mitral valve repair is preferred whenever technically feasible over valve replacement for degenerative mitral valve disease. The cardiothoracic surgeons at Wake Forest Baptist Health have pioneered a procedure for heart valve repair that surgeons are now using around the world.
Our Heart Center surgeons helped develop a better technique for exposing the valve during heart valve replacement surgery and have used this technique for mitral valve repair with great success. Repair techniques developed have been shown to be very effective. Long-term data support the durability of mitral valve repair.
Having your own natural tissue is preferable to synthetic tissues or tissues from an animal. Mechanical and biologic prosthetic heart valves have some disadvantages, including the need for lifelong medication to prevent complications from blood clots for mechanical valves, and relatively short life expectancy of up to 14 years for stented tissue valves. Sometimes it is not possible to repair the valve, particularly if it is heavily calcified like rock. Then it does have to be replaced.
During surgery the patient is attached to a heart-lung machine so that the heart is completely isolated from the body. This way the heart can be stopped, opened up and examined so the surgeon can see exactly what is going on with the mitral valve and confirm exactly what needs to be done to repair the valve. The repair may involve removing calcium deposits, repairing the cords that control the movement of the leaflets or adding tissue or a band around the outside of the valve for added support.
The heart is protected during surgery, is kept at the proper lower temperature and is regularly injected with nourishing blood. The heart resumes activity after surgery when blood circulation returns. The patient is then taken off the heart-lung machine.
Can I return to a normal life if my mitral valve is repaired?
In the days following surgery, patients are able to resume regular physical activity with relative ease. The workload on their heart has dramatically decreased and they feel much better.
Learn more about Cardiothoracic Surgery at Wake Forest Baptist Medical Center.