Q:
Hello – i have just been diagnosed with “Mitral valve regurgitation ” i have apparently had a leaking heart since birth and my valve has prolapsed. and is now leaking.
I have seen a cardiologist who has done an echo and a stress test she has advised that the leak is quite moderate and has organized for me to have a transesophagul ultrasound and an angiogram on Tuesday.-i am on lasics at the moment and she has advised that open heart surgery is quite a strong possibility.
Do you think that there are other options for me and another concern is that i have had severe rheumatoid arthritis for the last 12 years and have been on cortisone,celebrex and humira for a long time will this be a problem with surgery.i am very confused and concerned.
A:
Depending on how severe the Mitral valve regurgitation is, you may need indeed a heart operation. In the hands of an experienced surgical team, repair of your valve is the preferred option. Make sure you insist on having a surgeon with lots of experience in that area.
Take a look here for information about how your heart works:
http://www.cardiac-risk-assessment.com/heart-information/anatomy-of-heart
The reason for the ultrasound and angiogram (“cardiac catherization”) is to make sure your coronary arteries don’t have blockages that would need fixing at the same time as your valve repair.
http://www.cardiac-risk-assessment.com/heart-disease-diagnosis
Rheumatoid arthritis and its treatment influences how you would need to get ready for the surgery; most likely you will have to stop medications for awhile, but that kind of thing happens all the time!
Your human heart has four valves (flaps made of tissue) that control the direction of blood flow in the circulation. Normal valves act like a system of one-way doors, guiding blood flow through the various chambers of the heart. The aortic and mitral valves are part of the “left” heart and control the flow of oxygen-rich blood from the lungs to the body, while the pulmonic and tricuspid valves are part of the “right” heart and control the flow of oxygen-depleted blood from the body to the lungs.
What are the symptoms of a leaking mitral valve?
Many patients with mitral valve disease are have no symptoms, even with a leak that is severe. When symptoms develop, they include shortness of breath, fatigue, loss of energy, swelling of the ankles and palpitations (extra or skipped heart beats).
How is a leaky mitral valve diagnosed?
The first step involves listening with a stethoscope. Using a stethoscope, the doctor hears a murmur, which represents turbulent blood flow across an abnormal valve. The diagnosis is confirmed by an echocardiogram.
What is mitral valve prolapse?
Mitral valve prolapse is a common condition in which the mitral valve leaflets are floppy or loose. Mitral valve prolapse is diagnosed by ECHO. Most patients with mitral valve prolapse do not have a leaky valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should be considered.
Mitral Valve Prolapse
What are the indications for surgical repair of a leaking mitral valve?
Surgery should be considered when the leak is severe. When a patient with mitral regurgitation develops symptoms, a decreased heart function, or an increase in heart size, surgery is recommended.
What is the chance that a leaky mitral valve can be repaired?
Nearly 100%. The most common cause of mitral regurgitation is a condition called degenerative mitral valve disease—this is also called mitral valve prolapse, myxomatous mitral valve disease, and a floppy mitral valve. Such valves can be repaired (rather than replaced) in more than 95% of patients.
What is the risk of mitral valve surgery?
For asymptomatic patients having mitral valve repair, the operative risk is approximately 1 in 1000. Risk in symptomatic patients remains well under 1%. The presence of coronary artery disease or other conditions that require surgical treatment will affect your individual risk.
What is the durability of a mitral valve repair?
After mitral valve repair, 95% of patients are free of reoperation at 10 years, and this statistic is similar at 20 years. Thus, reoperation is uncommon after a successful mitral valve repair. An echocardiogram is recommended annually to assess valve function. In addition, patients who had valve surgery must take steps to prevent infection and reduce the risk of endocarditis (an infection of the valve).
Why is it important to have my surgery at a center with a large experience in mitral valve repair?
Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant) mitral valve and for many with a narrowed (stenotic) mitral valve.
Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually avoids the need for long-term use of blood thinners (anticoagulation).
Advantages of Mitral Valve Repair
- Better early and late survival
- Improved lifestyle
- Better preservation of heart function
- Lower risk of stroke and infection (endocarditis)
- No need for blood thinners (anticoagulation)
Mitral valve repair is more challenging than mitral valve replacement, and experienced surgeons are more likely to be able to repair the valve and ensure an excellent outcome.
Mitral valve repair is now well established and is applicable in practically all patients. The addition of a bypass to a blocked coronary artery is best performed at the time of the repair. You could expect to be in hospital for about a week and face a recovery of about two months. You would also experience a major improvement in the quality of your life because your heart finally has a chance to function as it should!
Hope this helps,
Dr T