For blood to go in only one direction, forward, it must pass through the heart valves, which function as one-way doors, opening and shutting with each beat of the heart. Just as there are four chambers to the heart, there are four heart valves. Blood must pass through one of these valves each time it leaves a chamber.
The Four Heart Valves:
- Tricuspid: The tricuspid valve is named because it has three leaflets. It is located between the right atrium and right ventricle.
- Pulmonary: The pulmonary valve is named because it is located below the pulmonary artery, between the right ventricle and the pulmonary artery.
- Mitral: The mitral valve is named because it looks like an upside down bishop’s hat or mitre. It is the only heart valve with two leafets; all of the others have three. It is located between the left atrium and left ventricle.
- Aortic: The aortic valve is named because it is located below the aorta, between the left ventricle and aorta.
The mitral valve is one of the two main valves on the left side of your heart. Normally, the mitral valve has two flaps (leaflets) that open and close, allowing blood to flow from your left atrium to your left ventricle and preventing it from flowing backward into your heart. Mitral valve disease occurs when the mitral valve doesn’t work properly.
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TYPES OF MITRAL VALVE DISEASE
- Stenosis – the valve doesn’t allow enough blood flow
- Regurgitation – blood leaks backwards out of the valve
Mitral valve stenosis is most commonly caused by inflammation from rheumatic fever, a disease that is related to strep infections; however, rheumatic fever is rare in the India and other developed countries, so mitral valve stenosis is becoming less common.
Mitral valve regurgitation can develop slowly (chronic) or suddenly (acute). Chronic regurgitation can be caused by a number of diseases and conditions, including heart infection (endocarditis), high blood pressure, coronary artery disease, and mitral valve prolapse, in which the flaps bulge backwards when your heart contracts.
Acute mitral valve regurgitation is caused by a sudden rupture due to a heart attack, chest injury, or inflammation.
Some people may be born with mitral valve abnormalities (congenital).
CAUSES AND SYMPTOMS OF MITRAL VALVE DISEASE
- Cough – A forceful release of air from your lungs
- Shortness of breath – Feeling that you cannot get enough air
- Chest pain – Discomfort that can be mistaken for indigestion or heartburn
- Dizziness – Feeling faint, woozy, weak or unsteady
- Swollen feet or legs – Buildup of fluid in the ankles, feet and legs
- Fatigue – Feeling easily tired
DIAGNOSIS AND TREATMENT OPTIONS
Your cardilogy doctor can usually diagnose mitral valve disease based on your medical history, risk factors, a physical exam, and results from tests and procedures.
There is no one test that can diagnose mitral valve disease, so your doctor may recommend one or more of the following: electrocardiogram (ECG), echocardiogram ( 2D echo), chest x-ray, blood tests, and coronary angiography. For more information on these tests, visit the common diagnostic tests page.
A faulty mitral valve that is not causing symptoms may not need any treatment, and mild symptoms may be treated with medication. With more severe symptoms, surgery may be required.Doctors will often repair the mitral valve when possible, but replacement is sometimes necessary.
Medication cannot correct a faulty mitral valve, but it can help reduce symptoms. Potential medications include those that affect your blood pressure, heart rate, or the amount of extra fluid in your body.
Mitral Valve Repair
If your symptoms are more severe, your mitral valve may need to be repaired. A cardiothoracic surgeon can perform a surgical procedure to remove or reshape tissue, patch holes or tears in the valve, or separate flaps that have fused together.
There are two different surgical approaches that can be utilized: traditional or minimally invasive.
During traditional mitral valve surgery, the cardiothoracic surgeon makes a 6- to 8-inch long incision down the center of your sternum (breastbone) to open the chest, providing direct access to your heart.
In minimally invasive surgery, the surgeon makes a 2- to 4-inch, J-shaped incision that opens part of your chest. This can potentially reduce hospital stay.
Minimally invasive surgery is not appropriate for all patients, but your surgeon will review the recommended approach to surgery that is safest for you based on your individual symptoms and circumstances.
Mitral Valve Replacement
If the mitral valve is too damaged, it may need to be replaced. There are two options for mitral valve replacement—mechanical valves (metal) or biological valves (tissue).
The principal advantage of mechanical valves is their durability—they do not wear out; however, blood tends to clot on mechanical valves, so patients must take blood thinning medication (anticoagulants) for the rest of their lives. There is also a small risk of stroke due to blood clotting.
Biological valves usually are made from animal tissue. Biological valves are less likely to cause blood clots, but they also are less durable than mechanical valves and may need to be replaced in the future.
Like mitral valve repair, replacement can be done minimally invasively or with traditional open heart surgery.
Your medical team will discuss the advantages and disadvantages of both valve types with you prior to surgery.