WHAT IS MITRAL VALVE REGURGITATION?
Complications from Mitral Regurgitation
Congestive Heart Failure (CHF) CHF occurs when increased pressure in the atrium causes fluid accumulation (congestion) in the lungs, or when the reduced forward flow of blood from the ventricle to the body deprives organs of the proper circulation of blood. The left ventricle may dilate and weaken, contributing to heart failure.
Atrial Fibrillation, stroke and other complications The increased blood pressure in the left atrium increases blood pressure in the veins leading from the lungs to the heart (pulmonary veins) and causes the left atrium to enlarge to accommodate the extra blood leaking back from the ventricle. An extremely enlarged atrium often beats rapidly in an irregular pattern, a disorder called atrial fibrillation. This condition reduces the heart’s pumping efficiency because the fibrillating atrium is quivering rather than pumping. Consequently, blood does not flow through the atrium normally, and blood clots may form inside the chamber. If a clot breaks loose (becoming an embolus), it is pumped out of the heart and may block an artery, possibly causing a stroke or other damage.
Symptoms of Mitral Regurgitation
Causes of Mitral Regurgitation
Diagnosis of Mitral Regurgitation
Treatment of Mitral Regurgitation
Surgery is necessary for those with severe regurgitation and is recommended for moderately severe regurgitation, if the cause is ischemic. Surgery must be performed before the left ventricle becomes irreversibly enlarged and weakened. Surgery may involve repairing the valve or replacing it with an artificial (prosthetic) valve. Repairing the valve eliminates regurgitation or reduces it enough to make the symptoms tolerable and prevent further damage to the heart. For heart valve repair or replacement, the procedure is performed with the support of the heart-lung machine and with open-heart surgery.
Surgery: Valve Repair
Repairing the valve is preferable to replacing it, if possible, because a repaired valve preserves the native architecture within the heart. The damaged valve is repaired and tightened with a prosthetic ring called Annuloplasty Ring. Repair usually functions better than replacement with a mechanical or bioprosthetic valve and the person may not require lifetime anticoagulation therapy.
Surgery: Valve Replacement
A damaged mitral valve may be replaced with a mechanical valve (a bileaflet valve made of pyrolite carbon in a stainless-steel housing) or with a bioprosthetic valve made of heart valve tissue (usually from pigs) mounted on a synthetic ring. Replacing the valve is more irreversible and while reducing regurgitation, it carries additional risks. Replacement imposes an artificial device or prosthesis in the blood stream, which is prone to tissue reaction, clot formation and infection.
Choice of a valve depends on many factors, including characteristics of the valve. A mechanical valve lasts longer than a bioprosthetic valve but requires that anticoagulants be taken indefinitely to prevent the formation of blood clots on the valve. A bioprosthetic valve rarely requires the use of anticoagulants but has a life of 12 to 15 years. Whether the patient can take anticoagulants may determine which valve is selected. For example, anticoagulants may not be appropriate for women of childbearing age because anticoagulants cross the placenta and may affect the fetus. Other considerations include the person’s age, activity level and relative heart function.
During replacement surgery, the valve is partially removed, and the replacement valve is sewn in place. The incisions are closed, the heart-lung machine is disconnected, and the heart is restarted. The operation takes from 2 to 5 hours. For some individuals, the mitral valve can be replaced using a less invasive procedure (without cutting through the sternum) available at some medical centers. The length of the hospital stay varies from person to person. Full recovery may take 6 to 8 weeks.
Precautions for individuals with Heart Valve Disease
Damaged heart valves are susceptible to a serious infection by bacteria (infective endocarditis). People with a damaged or an artificial valve should take antibiotics before surgical, dental, or medical procedures to reduce the risk of an infection on a valve, even though this risk is small. Atrial fibrillation, if present, may require treatment, including use of anticoagulants to prevent clots.