Mitral Valve Repair
The mitral valve is the valve between the main pumping chamber of the heart, the left ventricle, and left atrium. The mitral valve commonly leaks or becomes ...
The mitral valve is the valve between the main pumping chamber of the heart, the left ventricle, and left atrium. The mitral valve commonly leaks or becomes incompetent (mitral regurgitation), resulting in a large amount of blood leaking backwards from the heart into the lungs.
Less commonly, the mitral valve can become narrowed (or stenotic) limiting blood flow from the lungs into the heart. Mitral valve disease can be due to myxomatous degeneration, due to a heart attack, due to a weak and dilated heart from rheumatic disease or due to endocarditis (infection in the heart).
The mitral valve sits close to major structures including the circumflex coronary artery, the coronary sinus (main vein draining the heart), the aortic valve, and the main conduction pathway of the heart. Great care is taken to prevent injury to these structures during mitral valve operations.
Mitral valve disease can be asymptomatic and is often identified as a “heart murmur” by your doctor. Symptoms do develop and include heart failure, shortness of breath, and fatigue and palpitations. Mitral disease can also lead to atrial fibrillation, or an irregular heart beat.
How is Mitral Valve Disease Treated?
The primary goal with mitral valve operations is to repair the valve using the patient’s own valve rather than replacing it.
UVA's surgeons have a long history of expertise and excellence in mitral valve repair that began in the 1990s. In fact, many techniques of valve repair were developed here at UVA.
We currently repair 90-95% of mitral valves due to degenerative disease or ischemic disease. We have demonstrated superior results with repair than with replacement. We're also involved in multiple clinical trials designed to treat the mitral valve through the NIH (National Institutes of Health). Contact us to see if you are eligible for these clinical trials.
Transcatheter Mitral Valve Repair
UVA cardiologists and surgeons are pioneers in the development of transcatheter mitral valve repair using a small clip-like device. This implant is threaded by a catheter (tube) that is inserted into a vein in the leg and advanced into the heart. Using ultrasound guidance, the device is then implanted on the leaking portion of the mitral valve to repair it. This procedure can be done without stopping the heart and without a incision on the chest. Initial results have been very encouraging.
Although our preferred approach is to repair the mitral valve, in some cases, this is not possible. In this case, we replace the mitral valve with a bioprosthetic or a mechanical valve. Bioprosthetic valves can last 10-15 years and only require aspirin, while mechanical valves have the potential to last for the entire life of the patient but require a strong blood thinner (Warfarin, Coumadin). You and your surgeon can decide which valve is best for you and your lifestyle.
Minimally Invasive Operation
In many cases of isolated mitral valve disease, we perform these operations through a minimally invasive approach. This is performed either through a partial opening of the breast bone or through a small incision on the right chest between the ribs without a sternotomy (cutting of the sternum). The size of the incision is about 2-3 inches. UVA's surgeons also have expertise in treating atrial fibrillation during mitral valve surgery.
With the help of our world-class cardiologists, we use 3-D echocardiography, which allows us to understand why the valve is leaking, how we should repair the valve and how successful the repair is before the patient leaves the operating room.
At UVA our cardiac surgeons and cardiologists are now performing mitral valve repair surgery percutaneuosly in high-risk patients. Using only one small incision in the groin, a small clip is advanced into the heart to repair the leaky mitral valve. This can be done without stopping the heart and without a incision on the chest. Initial results have been very encouraging.
In cases where the mitral valve needs to be repaired/replaced, in addition to other procedures on the heart (like coronary artery bypass grafting or other valve operations) the operation is performed through a full sternotomy (opening breast bone).