What're the treatments for mitral regurgitation?
The treatment of mitral regurgitation depends on the acuteness of the disease and whether there are associated signs of hemodynamic compromise. Treatment focuses on maximizing your heart's function, minimizing your signs and symptoms, and avoiding future complications. Some people, especially those with mild regurgitation, need no specific treatment. However, even if you don't have signs and symptoms with mitral regurgitation, the condition requires monitoring by your
doctor. You'll need regular evaluations, with the frequency depending on the amount of regurgitation. Observation isn't the same as ignoring the condition. Actively observing the stability or the progression of the disorder is important so that you can receive the right treatment at the right time.
Medications
Currently, no medication can correct a deformity of a mitral valve. Patients with mitral regurgitation in which the left ventricle has already decompensated or who cannot undergo surgery for other reasons (e.g., severe lung disease, advanced cancer) may be treated with several medications to decrease symptoms. By decreasing the amount of salt and fluid in the body, diuretics decrease the amount of fluid that accumulates in the lungs and causes breathing problems. In very simplified terms, ACE inhibitors help "open up" (dilate) the arteries of the body, making it easier for the heart to pump blood forward into the aorta and throughout the body, thus decreasing the amount of blood that regurgitates across the leaky mitral valve back into the left atrium. The angiotensin receptor blockers (ARBs) are a new class of medications that are similar in some respects to ACE inhibitors. Angiotensin receptor blockers act to help "open up" (dilate) the arteries of the body, making it easier for the heart to pump blood throughout the body. Digoxin (Lanoxin®) acts to help the heart pump a little more vigorously, which leads to a modest increase in the ejection fraction (the percentage of blood pumped out of the left ventricle with each contraction).
Surgical Treatment
The only proven treatment for mitral regurgitation is surgery, although medication may temporarily decrease symptoms. There are two symptoms that predicate mitral valve surgery: falling ejection fraction and dilation (increased diameter) of the left ventricle.
Valve repair. Mitral valve repair is a surgery to preserve your own valve. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annulus). This is called an annuloplasty.
Valve replacement. Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. The two types of artificial valves are mechanical and tissue. Mechanical valves, which are made of metal, may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve, the valve won't work properly. If a clot breaks free of the valve, it could lodge in an artery to your brain, blocking blood flow to your brain and causing a stroke. Tissue valves are made from biologic tissue such as a pig's valve. These kinds of valves are called bioprostheses. They may wear out over time and may need replacement in another operation. However, an advantage of the tissue valve is that you don't have to use long-term anticoagulant medication. Your doctor can discuss with you the types of heart valves. The results with either type of valve tend to be very good.
Mitral valve repair or replacement generally involves open-heart surgery, done under general anesthesia. Through an incision the length of your breastbone (sternum), your heart is exposed and connected to a heart-lung machine that assumes your breathing and blood circulation functions during the procedure. Your surgeon then replaces or repairs the valve. After the operation, you'll spend one or more days in an intensive care unit, where your heart function and general recovery are closely monitored. |
More information on mitral valve diseases (mitral valve prolapse, mitral valve regurgitation, mitral stenosis)
What is mitral valve disease? - There are many diseases which affect the mitral valve and its supporting structures. The most common disorder of the mitral valve is the partial backflow.
What is mitral valve prolapse? - Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of a thickened mitral valve leaflet into the left atrium during systole.
What causes mitral valve prolapse? - The cause of mitral valve prolapse is unknown. It is more common in people with low body weight and low blood pressure.
What're the symptoms of mitral valve prolapse? - Symptoms of mitral valve prolapse include fatigue, palpitations, chest pain, anxiety, migraine headaches, and even stroke.
How is mitral valve prolapse diagnosed? - Mitral valve prolapse is diagnosed in the course of a physical examination. Echocardiography is useful in diagnosing a prolapsed mitral valve.
What're the treatments for mitral valve prolapse? - Most people with mitral valve prolapse (MVP) do not have symptoms or need treatment. Mitral valve prolapse can be treated with surgical replacement of the mitral valve.
What is mitral valve regurgitation? - Mitral valve regurgitation happens when some of the blood in your heart leaks from the left ventricle into the left atrium.
What causes mitral valve regurgitation? - The causes of primary mitral regurgitation include myxomatous degeneration of the mitral valve, ischemic heart disease, coronary artery disease.
What're the symptoms of mitral regurgitation? - The symptoms associated with mitral regurgitation are dependent on which phase of the disease process the individual is in.
What're the complications of mitral regurgitation? - Complications of mitral regurgitation include congestive heart failure, atrial fibrillation, blood clot, endocarditis.
How is mitral regurgitation diagnosed? - The diagnosis of mitral regurgitation usually employs imaging studies such as echocardiography or magnetic resonance angiography of the heart.
What're the treatments for mitral regurgitation? - The treatment of mitral regurgitation depends on the acuteness of the disease and whether there are associated signs of hemodynamic compromise.
What is mitral valve stenosis? - Mitral valve stenosis is a narrowing of the opening of the mitral valve in the heart. Stenosis of the mitral valve prevents the valve from opening normally.
What causes mitral stenosis? - Mitral stenosis is often caused by having had rheumatic fever. Rheumatic fever can cause an infection in the mitral valve.
What are the symptoms of mitral stenosis? - Symptoms of mitral stenosis include shortness of breath, fainting, dizziness or tiredness, chest pains (angina), chest infections.
How is mitral valve stenosis diagnosed? - Mitral valve stenosis is usually detected by a physician listening to heart sounds. The diagnosis of mitral stenosis is most easily made by echocardiography.
What're the treatments for mitral stenosis? - The treatment options for mitral stenosis include medical management, surgical replacement of the valve, and percutaneous balloon valvuloplasty.
Mitral valve repair and replacement - Mitral valve replacement surgery is open-heart surgery that is done while the patient is under general anesthesia. |
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