Mitral Valve Surgery

The mitral valve is situated between the left atrium and left ventricle in the heart. Surgery may be required to repair or replace a leaky or stiff mitral valve.

Mitral valve repair and replacement can be done both by the open-heart procedure and the minimally invasive surgery.

Causes of Mitral Valve Disease

Mitral valve disease has many causes. These include rheumatic fever, infection of the heart valves, coronary artery disease, heart failure, autoimmune disease like lupus, etc. Some forms of mitral valve disease may be congenital.

Risk of mitral valve disease can increase due to old age, usage of certain drugs, radiation to the chest, etc.

Mitral valve disease results in following pathologies:

  • Mitral valve regurgitation: In this the valve is leaky with some blood leaking back into the left atrium instead of moving forward into the left ventricle. It is usually caused by mitral valve prolapse.
  • Mitral valve stenosis:In this the valve narrows and is unable to open fully and prevents sufficient blood from flowing through the left atrium into the left ventricle.

Mitral Valve Repair Surgery

Surgery may be required to perform mitral valve repair if the patient has conditions like severe regurgitation where left ventricle is not able to pump enough blood to the body because it leaks back to left atrium and over time it results in enlarged and weak heart etc.

Mitral valve repair techniques include:

  • Ring annuloplasty: In this procedure any abnormal section of the valve is removed following which the edges are sutured together and a cloth-covered ring is placed around the valve.
  • Triangular or quadrangular resection:Surgeons use this technique for posterior leaflet prolapse by resecting or removing the damaged part of the leaflet and sewing the remaining edges together.
  • Chordal repair:This technique is used to repair anterior as well as posterior leaflet prolapse by replacing the some of the chords supporting the mitral valve and attaching new chords.
  • Commissurotomy:This is a surgery in which the mitral valve flaps are separated to relieve stenosis.

In cases where damaged mitral valves cannot be repaired they have to be replaced.

Mitral Valve Replacement Surgery

If there is too much of damage to the mitral valve a replacement surgery will become necessary. In this procedure, the diseased valve is removed and replaced with a new valve. This can be either a mechanical valve or a biological valve.

  • Mechanical valve:In this the mitral valve is replaced with a man-made valve from materials like carbon and titanium.
  • Biological valve:Here the replacement valve is made from animal or human heart tissue.

The surgery takes around 2 to 4 hours. After the surgery, the patient has to spend a day or two in the ICU and few more days in the hospital room depending on his specific condition.

Advantages of mitral valve repair over replacement

There are many advantages of mitral valve repair surgery over mitral valve replacement surgery. These include:

  • Better survival rates
  • Better heart function
  • Lower risk of stroke and infection
  • No need of blood thinners after surgery

The cardiac surgeon will recommend a repair over replacement, whenever possible. However, replacement surgery may be a better option in some situations. It also takes lesser time than repair surgery, and is less complex to perform.

Life after surgery

After surgery patients experience reduced symptoms and improved quality of life. Patients with mitral valve replacement using a mechanical valve will have to take blood thinners to prevent blood clots.

Regular health check-ups are required to ensure that the new or repaired valve is working properly. Patients may need to undergo cardiac rehabilitation to improve their health after the surgery. They also need to adopt a healthy lifestyle with regular exercise, healthy diet, stress management, avoiding smoking, etc.