When is heart valve repair surgery necessary?
A heart valve repair can be performed on a valve that is too narrow to allow sufficient blood to flow through the valve opening (stenosis) or on a valve that cannot close tightly enough to prevent back flow of blood (insufficiency). The mitral valve is especially suited to reparative techniques because its component parts - any of which may be the cause of the valve's
malfunction - often can be repaired. Repair of a stenotic valve may involve cutting or separating the valve leaflets, or other components, to widen the valve opening. Repair of an insufficient valve may be achieved by narrowing or shortening the supporting structures to allow the valve to close tightly, or by inserting one of a variety of prosthetic rings to reshape a deformed valve.
The terms annuloplasty and valvuloplasty are often used to categorize the type of repair. An annuloplasty describes a procedure performed on the valve annulus, the ring of tissue that supports the valve leaflets. A valvuloplasty is a broad category that refers to reconstructing one or more components of the valve; the leaflets, annulus, chordae tendineae and/or papillary muscles that anchor the leaflets to the heart wall. For example, excess leaflet tissue can be removed or a dilated annulus can be made smaller with stitches.
In addition to the surgical procedures, percutaneous balloon valvuloplasty is a non-surgical treatment option that is performed for heart valve stenosis. This procedure is performed in the cardiac catheterization laboratory by cardiologists trained in adult and/or pediatric valve procedures. The cardiologist threads a balloon-tipped catheter through a large artery into the narrowed valve opening. The balloon is inflated, thereby enlarging the valve orifice.