Surgery for mitral valve problems

If you have a severe case of mitral regurgitation, mitral valve prolapse or mitral valve stenosis, you will usually need to have a heart valve operation.

Most heart valve operations are performed under general anaesthetic (where you are asleep). They usually involve making a cut down the middle of the breastbone, although some surgeons are increasingly carrying out these operations using small incisions between the ribs (a 'minimal access' approach).

Sometimes it's possible to perform the surgery using a 'percutaneous' method, which involves feeding a catheter (thin, flexible tube) into a large vein in your neck or groin and guiding this through to your heart. People tend to recover more quickly from this procedure, but the results are often less predictable.

The most commonmitral valve procedures are:

  • mitral valve repair surgery
  • mitral valve replacement surgery
  • percutaneous balloon valvuloplasty

Theseprocedures are briefly explained below, but your surgeon or heart specialist will explain any operation in detail to you, including the risks and benefits.

It is also possible to carry out procedures similar to mitral valve repair using percutaneous techniques, but these are not covered in any detail here because they not widely used and there are still some uncertainties about them. For more information, you can read:

  • NICE guidelines on percutaneous mitral valve repair for mitral regurgitation
  • NICE guidelines on percutaneous mitral valve annuloplasty

Mitral valve repair surgery

Repairing the mitral valve flaps is the main surgical treatment for mitral regurgitation.

The operation is carried out under general anaesthetic and your surgeon will usually gain access to your heart through an incision made along your chest. Some surgeons may also perform this type of operation using laparoscopic (keyhole) techniques , and the advantages of this approach are still being evaluated.

The twoflaps of the mitral valve are then partially clipped or sewn together to reduce the amount of blood leaking backwards by keeping the flaps close together during each heart contraction.

This operation is generally successful, with only a small chance of major complications.

Mitral valve replacement surgery

Mitral valve replacement is usually only considered if you're unable to have the valve repaired. You will need it if your valve is furred up with calcium deposits or if the leaflets of your valve do not move.

During surgery, yourmitral valve is replaced with either a mechanical or bioprosthetic valve, which is made from animal tissue.

This is major open heart surgery performed under general anaesthetic and usually involves making an incision along your chest. You'll be put on a heart-lung bypass machine during the operation, which takes over the function of your heart and lungs while the procedure is carried out.

You will usually need to take medication to prevent blood clots for a long period after this operation.

This operation is generally successful, with a small chance of major complications, although the risk of serious and life-threatening problems is generally higher than with mitral valve repair surgery.

Percutaneous balloon valvuloplasty

Balloon valvuloplasty, also known as percutaneous mitral commissurotomy, is a non-surgical treatment option for mitral valve stenosis. It's usually performed by a cardiologist (heart specialist) using just a local anaesthetic (where you remain awake but your skin is numbed).

A catheter is inserted through your skin via a large vein in your groin or neck and passed through to your heart. The tip of the catheter, which has a balloon attached, is positioned directly inside the narrowed valve. The balloon is inflated and deflated several times to widen the valve opening, before the balloon is deflated and removed.

This procedure is most commonly used in young patients who do not have too much calcium deposited on their valve, pregnant women, and patients who are at an increased risk of developing complications from a mitral valve replacement (see above).

Using this method is generally less predictable and less reliable than accessing the valve directly, although recovery is generally faster.



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Medically Reviewed by a doctor on 21 Dec 2018