These problems often develop with age — for example, because of "wear and tear" over time or damage caused by untreated high blood pressure. Mitral valve stenosis is where the mitral valve does not open as wide as it should, restricting the flow of blood through the heart.
One of the main causes of mitral valve stenosis is rheumatic heart disease. This is where an infection causes the heart to become inflamed. Over time, it can cause the flaps of the mitral valve to become hard and thick. Other causes include hard deposits that form around the valve with age, or a problem with the heart from birth congenital heart disease. Mitral valve surgery may be recommended if you have symptoms caused by a problem with your mitral valve or if the problem is quite serious.
Mitral valve repair is an operation to make the flaps of the mitral valve stay closer together. This will help stop blood flowing the wrong way through the valve. It's mainly used to treat mitral valve prolapse or regurgitation, if the problem is serious and causing symptoms. The operation is carried out under general anaesthetic , where you're asleep. Your surgeon will usually get to your heart through a single cut along the middle of your chest, but smaller cuts between your ribs are sometimes used.
The operation may be done as keyhole surgery, where a small clip is attached to the mitral valve to help it close. Most people experience a significant improvement in their symptoms after surgery, but speak to your surgeon about the possible complications. Research Clinical Trials Journal Articles. Resources Reference Desk Find an Expert. For You Children Patient Handouts. This can cause Palpitations feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast Shortness of breath Cough Fatigue, dizziness, or anxiety Migraine headaches Chest discomfort Most people who have mitral valve prolapse MVP don't need treatment because they don't have symptoms and complications.
Start Here. Diagnosis and Tests. Related Issues. Clinical Trials. However, some of them have shown superior performance and accuracy in open-heart surgery 41 and should probably be preferred when assessing the operative risk in candidates to early MV repair. As far as valve repairability is concerned, two-dimensional echo imaging using transthoracic and transoesophageal approaches provides most of the relevant information.
However, particularly in complex MV lesions, real-time three-dimensional transoesophageal echocardiography has significantly enhanced the possibility to predict the feasibility of repair by giving a comprehensive and real-time dynamic view of the MV anatomy 42 , 43 Figure 5. Degenerative mitral disease with large posterior leaflet prolapse imaged by real-time three-dimensional transoesophageal echocardiography.
The mechanism of severe degenerative MR is of critical importance since MVs with anterior or bileaflet prolapse are significantly more difficult to repair than those with isolated posterior leaflet prolapse.
Severe degenerative MR due to segmental prolapse of the posterior leaflet can be treated with a very low risk of reoperation. Conversely, the risk of repair failure significantly increases in patients with MR due to lesions involving the anterior leaflet or both leaflets and in those with extensive annular calcification.
More recently, comparable long-term results have been reported in patients with posterior, anterior, and bileaflet prolapse, 51 , 60 and it is likely that in the most experienced centres, the progressive refinement of mitral repair strategies will neutralize anterior and bileaflet prolapse as incremental risk factors for recurrent MR after repair. Although selected centres might offer excellent rates of valve repair, those results cannot be extrapolated to the vast majority of cardiac surgery units where mitral repair is a relatively uncommon procedure and many patients with potentially reparable valves receive a replacement instead.
There was marked variability in the annual frequency of MV repair compared with replacement. The median number of isolated MV operations per year was 5 range 1— Following risk adjustment, age, sex, race, endocarditis, mitral pathology, urgency, and concomitant tricuspid or AF surgery were independently associated with altered probability of mitral repair. However, increased individual surgeon mitral volume was the most highly associated predictive factor, with an increased propensity to perform mitral repair both before and after all clinical covariate factor risk adjustments.
Until high-quality valve repair surgery will become widespread, an early repair strategy cannot be generally adopted. In asymptomatic patients without surgical triggers according to the current guidelines, an unsuccessful repair requiring unexpected prosthetic valve replacement should be a rather exceptional event since mortality and morbidity after MV replacement is not negligible.
Surgical MV repair is the treatment of choice for severe degenerative MR. The choice between early repair and watchful waiting should be individualized according to the specific characteristics of the patient, the surgical risk, the likelihood of an effective and durable repair, and the local surgical expertise.
Early repair may represent the preferred approach if the operative risk is low and the likelihood of a high-quality repair is very high. At the moment, such an early repair strategy cannot be widely adopted and should be reserved to advanced repair centres. Google Scholar.
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Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Timing of surgery in severe degenerative mitral regurgitation. Watchful waiting wait and see approach. Early repair. Controversies in Cardiovascular Medicine. Mitral valve surgery: wait and see vs.
Oxford Academic. Steven F. Revision received:. Select Format Select format. Permissions Icon Permissions. Abstract Mitral valve repair represents the optimal surgical treatment for severe degenerative mitral regurgitation.
Mitral regurgitation , Mitral repair , Surgical timing , Wait and see , Early repair. Figure 1. Open in new tab Download slide. Figure 2. Figure 3. Figure 4. Figure 5. Gillinov et al. Open in new tab. Google Scholar Crossref. Search ADS. Google Scholar PubMed. The mitral valve can be abnormal in two ways. First, the valve flaps may be oversized and thickened.
Second, the valve flaps may be "floppy. Some people's valves are abnormal in both ways. Either way can keep the valve from making a tight seal. Mitral valve prolapse MVP occurs in all age groups and in men and women. MVP with complications or severe symptoms most often occurs in men older than Most people who have mitral valve prolapse MVP aren't affected by the condition. This is because they don't have any symptoms or major mitral valve backflow.
Among those who do have symptoms, palpitations strong or rapid heartbeats are reported most often. Other symptoms include shortness of breath, cough , dizziness, fatigue tiredness , anxiety, migraine headaches, and chest discomfort.
MVP symptoms can vary from one person to another. They tend to be mild but can worsen over time, mainly when complications occur. Complications of MVP are rare. When present, they're most often due to the backflow of blood through the mitral valve. Mitral valve backflow is most common among men and people who have high blood pressure. People who have severe cases of backflow may need valve surgery to prevent complications. Mitral valve backflow causes blood to flow backward from the left ventricle into the left atrium.
Blood can even back up from the atrium into the lungs, causing shortness of breath. The backflow of blood puts a strain on the muscles of both the atrium and the ventricle.
Over time, the strain can lead to arrhythmias. Backflow also increases the risk of infective endocarditis IE , an infection of the inner lining of your heart chambers and valves. Mitral valve backflow can cause arrhythmias. There are many types of arrhythmia. The most common arrhythmias are harmless.
Others can be serious or even life threatening. When the heart rate is too slow, too fast, or irregular, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs. In AF, the walls of the atria quiver instead of beating normally. As a result, the atria aren't able to pump blood into the ventricles the way they should. AF is bothersome but rarely life threatening, unless the atria contract very fast or blood clots form in the atria.
Blood clots can occur because some of the blood "pools" in the atria instead of flowing into the ventricles. If a blood clot breaks off and goes into the bloodstream, it can reach the brain and cause a stroke. A deformed mitral valve flap attracts bacteria that may be in the bloodstream. The bacteria attach to the valve and can cause a serious infection called infective endocarditis IE.
Signs and symptoms of a bacterial infection include fever, chills, body aches, or headaches. IE doesn't happen often, but when it does, it's serious.
MVP is the most common heart condition that puts people at risk for this infection. You can take steps to prevent this infection. Floss and brush your teeth regularly. Gum infections and tooth decay can cause IE. Mitral valve prolapse MVP most often is found during a routine physical exam when your doctor uses a stethoscope to listen to your heart. Stretched valve flaps, as seen in MVP, can make a clicking sound as they shut. If the valve is leaking blood back into the atrium, a murmur or whooshing sound often can be heard.
However, these abnormal heart sounds may come and go. Thus, your doctor may not hear them at the time of an exam, even if you have MVP. As a result, you also may have diagnostic tests and procedures to diagnose MVP.
Echocardiography echo is the most useful test for diagnosing MVP. This painless test uses sound waves to create a moving picture of your heart. An echo provides information about the size and shape of your heart and how well your heart chambers and valves are working.
The test also can identify areas of heart muscle that aren't contracting normally due to poor blood flow or injury to the heart muscle. In MVP, an echo is used to look for prolapse of the mitral valve flaps and for backflow of blood through the leaky valve. There are several types of echo, including a stress echo. A stress echo is done before and after a stress test.
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