Mitral Valve Disease

Your heart is made up of four chambers consisting of two atria (left and right) and two ventricles (left and right), which are the main pumping chambers. One-way valves are positioned in between the atria and ventricles, and between ventricles and the great vessels to facilitate forward flow of the blood. The mitral valve lies between the two left-sided chambers. Mitral valve disease occurs when the valve between the left heart chambers does not function properly. There are main two types of mitral valve disease called mitral valve regurgitation and mitral valve stenosis. 

Mitral valve regurgitation, also called mitral insufficiency or mitral incompetence, occurs when the leaflets of the mitral valve become lax and blood leaks backward into the left atrium, causing the heart to work harder to pump the right amount of blood to the rest of your body. Mitral valve stenosis occurs when the mitral valve opening becomes narrow. At Yale Cardiac Surgery, our highly skilled surgeons perform the largest number of mitral valve operations in the state.

Treatment

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Severe mitral valve disease is generally treated by repairing the native valve or replacing it with an artificial valve.

With valve repair, your surgeon will try to restore your valve's competence using one of a variety of repair techniques designed to allow your valve leaflets to close properly. Most of these repair techniques involve the placement of an artificial, prosthetic ring around the valve opening; however, these rings do not require taking Coumadin long term. Valve repair is generally felt to have advantages over valve replacement. These advantages include maintenance of the normal geometry of the heart, avoidance of long-term Coumadin, and reduced risk of prosthetic infection.

If your own mitral valve cannot be repaired, it can be replaced with an artificial valve. There are two major classes of artificial valves: biologic valves made out of animal or human tissue and mechanical valves made out of fabric and metal. Mechanical valves are extremely durable, but generally require that you take a blood thinner called Coumadin for the rest of your life. Biologic valves do not require Coumadin, but they are less durable, generally lasting between 10 and 15 years; worn out valves often require another operation to replace them.

Frequently Asked Questions

The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. Mitral valve prolapse is one of the most common diseases to affect the mitral valve. In this condition, one or more of the leaflets swings too far backward into the left atrium during eachcontraction of the left ventricle, so that the leaflets do not close properly, allowing blood to leak between them.collapse
Mitral valves are better repaired than replaced for several reasons, not the least of which is location. The mitral valve—a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart—is s closely associated with its location in the heart. So repairing it preserves the natural geometry and attachments of the left ventricle which permits it to function efficiently. This is very important in patients who have abnormal heart function.

Also, a mechanical replacement requires patients to take a blood thinner such as coumadin or warfarin for the rest of their lives so as to prevent blood clots around the replacement. In addition to being a nuisance, this also creates a small risk of bleeding complications.
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The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. In fact, the mitral valve is the most commonly repaired heart valve. However the most common surgical approach to the mitral valve is to have the surgeon saw open the breastbone and spread the edges to gain direct access to the heart.

Mini-mitral repair is one of two minimally-invasive alternatives available (the other being robotic mitral repair). 

A mini-mitral repair uses a “mini-thoracotomy” which consists of a three-inch incision made through the right side of your chest between your ribs. The heart-lung bypass, required to stop your heart long enough for the surgeon to close the defect, is instituted with small tubes placed in the main artery and vein of your right leg through a one to two inch incision placed in the right groin crease. Your heart will then be stopped and the right atrium opened to expose the ASD. At this point, the surgeon will insert specialized hand-held “chopstick” like instruments through the incision to repair the defect. Once the defect is repaired, your heart will be closed and restarted. You will be disconnected from the heart-lung bypass and the incision will be closed.
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