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Mitral Valve Repair or Replacement 

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What is the mitral heart valve?
The mitral valve is a one-way valve deep inside your heart that connects the left atrium to the left ventricle. The mitral valve acts as the door between the upper and lower left chambers of the heart. When the mitral valve is damaged or diseased, it may affect the hearts ability to function efficiently, which can prevent normal blood flow from the heart and then out to the body, with serious consequences.

The mitral valve is the most commonly repaired heart valve. Two major disorders cause most of the problems:

Mitral valve prolapse, or regurgitation, occurs when the valve leaflets (or doors) don't close properly, allowing blood to flow backward into the left atrium. This is the most common ailment of heart valves, affecting 2 percent of the U.S. population, or 4 million Americans, in equal numbers among men and women. Nearly 250,000 people are diagnosed each year; 40,000 undergo surgery each year for mitral valve regurgitation. It is also called floppy valve syndrome.

Mitral valve stenosis is marked by a narrowed valve opening, thus making your heart work harder, often unsuccessfully, to pump the same amount of blood out to your body. About 60 percent of the people with mitral valve stenosis had rheumatic fever; this condition affects twice as many women as men. Doppler echocardiography, in combination with paced exercise, is the preferred diagnostic tool to evaluate mitral valve stenosis.

Your physician may be the first to know you have a mitral valve problem. The doctor may detect a clicking sound or irregular heartbeat when listening to your chest with a stethoscope.

Your doctor may monitor your health condition, try medical treatments or do a minimally invasive procedure called a balloon valvuloplasty to open the valve passage before determining surgery is needed. If surgery becomes necessary, there are two options:
Repair the mitral valve or
Replace the mitral valve

Your surgeon will first try to repair the valve through minimally invasive heart surgery. At Sentara, minimally invasive techniques are also possible to replace the valve. Your surgeon will discuss with you the benefits of implanting a mechanical valve or a biological valve (made from pig or cow tissue or by donation from a compatible human cadaver). Read about valve repair vs. valve replacement

Minimally Invasive Techniques
Sentara cardiothoracic surgeons have performed numerous mitral valve repair and replacements using minimally invasive surgical techniques since 2005. This results in smaller incisions, fewer incisions, less pain and bleeding and quicker recovery for patients. Physicians use sophisticated instruments and a tiny camera to operate in much smaller spaces.

Why Treat Mitral Valve Problems?
While you may not realize at first that you have a mitral valve problem, experience shows the symptoms will become progressively worse.

Also, a heart that cant pump out the blood leads to congestive heart failure if left untreated. The heart enlarges, trying to move more fluid, but it backs up into the heart and puts pressure on the lungs. This strain on the heart makes it weaker and less efficient at supplying your body with needed oxygen and nutrients that are carried in the blood and threatens other major organs in your body.

The blood tends to puddle in the left atrium, increasing the chance of blood clots in the heart. If the clots break loose and travel in the body, they may cause a stroke (in the brain) or a heart attack. Other symptoms of congestive heart failure are irregular heartbeat, or atrial fibrillation, a pounding sensation where the heart beats chaotically. The excess blood in the heart can back up into the lungs, causing pulmonary edema or lung congestion.

Mitral Valve Repair
Minimally invasive heart surgery is easier on the patient. Mitral valve repair is preferred for mitral valve stenosis because it preserves the valve and left ventricular function, it eliminates the risks of mechanical valve and the need for lifelong anti-coagulants. Repairs fall into three main categories:

commissurotomy: The edges of the valve leaflets, which form the opening for the valve, are fused partially together, restricting blood flow. The surgeon snips these apart.

resection: The valve opening is surgically reshaped to restore its function, or to remove extra tissue that causes leakage.

annulus support: If the valve is too wide or too floppy, a soft, sturdy ring is sewn around the valve to tighten the opening and give it extra support.

If the valve cannot be repaired, your surgeon will discuss valve replacement with you.

On average, patients who have had minimally invasive heart surgery with no complications are in the hospital for four days. In comparison, the average stay after a full, open-chest surgery is 5-7 days.

The process of healing from even small incisions may make you uncomfortable at first. Talk to your doctor or nurses if you think medication will be helpful. They can also recommend alternative pain relief remedies, such as warm compresses.

*Image from The Society of Thoracic Surgeons

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