Mitral Valve Disease
The mitral valve is located on the left side of the heart and lies between the left atrium (the upper heart chamber) and the left ventricle (the lower heart chamber). The mitral valve has two leaflets -or flaps- that open and close to regulate the flow of blood between these two chambers of the heart.
What is Mitral Valve Disease?
Mitral valve disease is the most prevalent form of valve disease. There are two common conditions that can affect the mitral valve's ability to regulate blood flow:
- Mitral valve stenosis occurs when the valve does not open completely, usually because of calcification, and obstructs blood flow.
- Mitral valve regurgitation occurs when the leaflets do not close completely and become “floppy,” causing blood to leak back (regurgitate) into the left atrium and decrease blood flow to the rest of the body.
Symptoms of Mitral Valve Disease
The heart of those who suffer from mitral valve disease has to work harder. Eventually this will cause a weakening of the heart muscle, which increases the risk of irreversible damage and heart failure. Someone with mitral valve disease will experience:
- Shortness of breath, particularly during exertion
- Heart palpitations
- Weakness and fatigue
- Chest pain (angina)
- Frequent respiratory infections or coughing, sometimes with blood-tinged sputum.
These symptoms will cause a decrease in one's quality of life and can become life-threatening if left untreated.
Treatment for mitral valve disease depends on how severe it is and how sick you are. Medications to treat symptoms may be prescribed. However, these medications only treat the symptoms and do not address the underlying disease.
Mitral valve disease can only be treated in two ways: mitral valve surgery or a MitraClip transcatheter mitral valve repair (TMVR).
The current preferred treatment is a surgical repair of the patient's valve. The surgeon accesses the heart through a sternotomy (opening of the chest bone) and excises or repositions the diseased valve leaflets. In instances where the valve is severely diseased, a surgeon will perform a valve replacement using a mechanical or bioprosthetic valve. For some patients, a minimally invasive surgical option is available where a mini or partial sternotomy is performed involving a smaller incision on the chest. The mitral valve is accessed between the ribs, therefore not requiring the breastbone to be spread. The advantage to surgery includes an improved quality of life and expanded life expectancy, as the flow to the heart becomes regulated.
On average, those who have mitral valve surgery can expect to remain in the hospital for 5 to 10 days post-surgery. The first 48 hours are spent on an intensive care unit (ICU) with the remainder of the hospital stay spent in a specialized cardiac care unit (intermediate care), or a regular bed.
Percutaneous Mitral Valve Repair
Currently, there is one approved device for a percutaneous repair of the mitral valve. The MitraClip is a catheter-based treatment available for patients with significant symptomatic degenerative mitral regurgitation. In this procedure, a metal clip is advanced on a catheter delivery system, most often through the femoral vein in the groin, and guided by a special type of ultrasound. The MitraClip device then clips the leaflets of the valve together to reduce the amount of blood that flows back into the left atrium.
Those who have had the MitraClip procedure are, on average, discharged from the hospital 24 to 48 hours post-procedure, barring any complications.