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Mitral valve diseases mitral valve prolapse causes of mitral valve prolapse symptoms of mitral valve prolapse diagnosis of mitral valve prolapse treatment for mitral valve prolapse mitral valve regurgitation causes of mitral valve regurgitation symptoms of mitral regurgitation complications of mitral regurgitation diagnosis of mitral regurgitation treatment for mitral regurgitation mitral valve stenosis causes of mitral stenosis symptoms of mitral stenosis diagnosis of mitral valve stenosis treatment for mitral stenosis mitral valve repair and replacement heart valve disorders {aortic valve disease aortic insufficiency aortic aneurysm aortic regurgitation aortic stenosis aortic valve replacement surgery pulmonic valve stenosis tricuspid regurgitation tricuspid stenosis heart valve replacement and repair}

Mitral valve repair and replacement

Heart valves are designed to control the direction of blood flow through the heart. The opening and closing of the heart valves produce the sound of the heartbeat. Mitral valve replacement surgery is used to replace a diseased mitral heart valve with a natural or artifical valve. Mitral valve replacement surgery is open-heart surgery that is done while the patient is under general anesthesia. An incision is made through the breast bone (sternum). Tubes are used to re-route the blood away from the

heart to a heart-lung bypass machine to keep the blood oxygenated and circulating while the heart is being operated on.

The heart's valves perform the important function of ensuring blood flow in the correct direction. The mitral valve directs the flow of blood from the left atrium into the left ventricle, and the aortic valve allows blood to pass from the left ventricle into the aorta. The tricuspid and pulmonary valves perform the equivalent task on the right side but are under considerably less pressure and, although they may suffer from similar disorders, are less likely to be so severely impaired as to require surgery. When the valve opening between the upper and lower chambers on the left side of the heart (mitral valve) becomes severely blocked (mitral stenosis), it usually requires surgery. Because the narrowing of the valve may cause blood to back up into the lungs, careful monitoring of symptoms such as shortness of breath is required, and surgery may be necessary to prevent serious heart failure. When the mitral valve closes improperly (mitral insufficiency or regurgitation), the desirability of surgery is usually determined by how severely the symptoms affect the patient's lifestyle and how well they can be controlled by medical treatment.

Mitral valve problems are rarely caused by a birth defect, otherwise known as a congenital condition. More often, simple "wear and tear" may cause part of the valve mechanism to fail. This is called "degenerative disease". This may be related to advancing age, although many young people will have this condition as well. Rheumatic fever may damage the mitral valve causing stenosis or regurgitation. Occasionally the mitral valve is damaged by infection or bacterial endocarditis. Ischemic heart disease (coronary artery disease) can also cause the mitral valve to leak.

Many mitral valves can be repaired, especially if they leak due to degenerative disease. A separate discussion of mitral valve repair will be available through this site. In many cases, however, the valve is too damaged to permit repair and the valve must be replaced with a prosthetic (artificial) valve. Valves damaged by rheumatic disease often must be replaced.

In general terms, there are two types of artificial valves available - mechanical valves made entirely from metal and pyrolytic carbon - or biological valves - made from animal tissues. Each has advantages and disadvantages with respect to durability (how long they will last) and risk of blood clots forming on the valve

There are a number of excellent mechanical prostheses available today. All perform equally well. The principle advantage of mechanical valves is their excellent durability. The valves available today simply do not wear out! Their main disadvantage is that blood has a tendency to clot on all mechanical valves. If this happens the valve will not function normally. Therefore, patients with these valves must take anticoagulants (blood thinners) for life. There is also a small but definite risk of blood clots causing stroke, even when taking anticoagulants.

There are a variety of biological alternatives for mitral valve replacement. Most are made from pig aortic valves. Their key advantage is that they have a reduced risk of blood clots forming on the valve itself causing valve dysfunction or stroke. The key disadvantage of biological or tissue valves is that they have more limited durability as compared with mechanical valves. They will wear out given enough time. The rate at which they wear out, however, depends on the patient's age. A young boy might wear out such a valve in only a few years, while the same valve might last 10 years in a middle aged person, and even longer in a patient over the age of 70. Of course, as we grow older we expect that we will not need the valve for as many years as our life expectancy is less. The general consensus is that a tissue valve will not need to be replaced if used in a patient over the age of 70 years.

Often the mitral valve is so damaged that it must be replaced (refer to Mitral Valve Replacement). Occasionally, however, the valve can be repaired rather than replaced. One type of repair is a procedure called mitral commisurotomy. Mitral commisurotomy can be performed for some valves that are narrow or "stenotic" either from birth or from damage by rheumatic fever. Most often today, rheumatic mitral stenosis is treated by balloon valvuloplasty, a procedure performed in the cardiac catheterization laboratory by interventional cardiologists. Using a catheter with a balloon on the end, the balloon is expanded inside the valve "stretching" it open.

More often mitral valve repair is performed to correct a leaking or regurgitant valve. Congenital mitral regurgitation may be due to a cleft mitral valve (a valve with a separation or cleft down the middle) associated with an atrial septal defect, a type of hole in the heart between the low pressure chambers or atria. Such valves can sometimes be repaired simply by closing the cleft with sutures. Valves regurgitant due to bacterial endocarditis can occasionally be repaired, however the majority of mitral valve repairs are performed for degenerative disease. Degenerative mitral valve disease may be due to an elongation or rupture of the chordal apparatus, the "heart-strings" that support the valve normally, or due to a more generalized weakness of the valve itself such as the "floppy valve" syndrome in which all of the components of the valve are enlarged and elongated.

Not all mitral valves can be repaired. A preoperative echocardiogram may help your surgeon predict the likelihood of repair, but cannot guarantee it. Mitral valves that are regurgitant due to rheumatic fever are often both stenotic and regurgitant, and are often beyond repair.

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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