What is the mitral valve?
Mitral valve surgery can be done with either conventional methods or transcatheter methods. The mitral valve is between the left atrium (upper chamber) and left ventricle (lower chamber). It ensures oxygen-rich blood moves through the right path in the heart before the left ventricle pumps it out to the body. However, if the flaps of the mitral valve do not close properly, the blood leaks backward into the left atrium (mitral valve regurgitation). This can cause symptoms such as irregular heartbeat, dizziness, shortness of breath, fatigue and chest pain. Eventually, this can lead to heart failure and heart rhythm disorders.
Mitral valve repair techniques
The mitral valve is particularly amenable to repair techniques using annuloplasty and valvuloplasty.
- Annuloplasty involves using a ring-shaped device sewn around the circumference of the valve to tighten its base. This allows the valve to have a tight seal when it closes.
- Valvuloplasty involves cutting away or sewing together redundant or loose parts of the mitral valve to make it close better.
Other repair techniques include:
- Cutting between the flaps of the valve (if they are stuck together)
- Reshaping the valve flaps so they fit together properly
- Removing the calcium that has built up around the valve flaps [note: this may be the same as valvuloplasty]
- Replacing or shortening the tissue cords that support the valve
- Patching up holes or tears in the valve flaps
Transcatheter methods of repairing the mitral valve with balloons, clips and other fasteners are becoming increasingly available for patients who are poor surgical candidates. Many of these techniques are still under investigation.
Mitral valve replacement alternatives
The mitral valve can be replaced with a synthetic alternative when repair is not advisable or possible. Synthetic valves are made from ceramic and titanium (mechanical), or made of biological tissue (bioprosthetic) from pigs, cows, horses or cadavers. Artificial valves are permanent, but require the patient to take blood thinners for a period of time. For mechanical valves, blood thinners must be continued indefinitely.
Mitral valve repair or replacement can be done through minimally-invasive non-traditional incisions. Although the incision in the center of the chest and cutting the breastbone is the standard approach, a smaller incision on the right side of the chest along the breast crease is a particularly attractive way to approach this valve through the rib interspace. Patients’ recovery, pain, and return to activities can be significantly impacted by using this approach.