Treatment

Mitral valve regurgitation treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse. The goal of treatment is to improve your heart's function while minimizing your signs and symptoms and avoiding future complications.

Watchful waiting

Some people, especially those with mild regurgitation, might not need treatment. However, the condition may require monitoring by your doctor. You may need regular evaluations, with the frequency depending on how severe your condition is.

Medications

Medication can't correct a mitral valve deformity. But medications such as diuretics can relieve fluid accumulation in your lungs or legs, which can accompany mitral valve regurgitation. Blood thinners (anticoagulants), which can help prevent blood clots, may be used if you have atrial fibrillation.

High blood pressure makes mitral valve regurgitation worse, so if you have high blood pressure, your doctor may prescribe medication to help lower it. Following a low-salt diet helps prevent fluid buildup and helps control blood pressure.

Surgery

Your mitral valve may need surgical repair, even if it's not causing symptoms. The American College of Cardiology and the American Heart Association recently issued new guidelines for mitral valve surgery, recommending earlier surgery for some people with primary mitral valve regurgitation — caused by an abnormality of the valve — even if they have no symptoms.

Mitral valve surgery should be done at a high-volume mitral valve surgery center with a reputation of excellence and cardiologists, imaging specialists and cardiac surgeons with experience in treating mitral valve conditions.

Discuss the risks and benefits of surgery with your doctor. Your surgery options include:

  • Valve repair. Mitral valve repair is a surgery that preserves your own valve. For most people with mitral valve regurgitation, repair is preferred to replacement. Surgeons can repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly.

    Frequently, repairing the valve includes tightening or reinforcing the ring around the valve (annulus). This is called an annuloplasty. Methods of repairing mitral valves without open-heart surgery are being used in select cases.

  • Valve replacement. If your mitral valve can't be repaired, your surgeon may replace it with a mechanical or biological valve.

    In this procedure, your surgeon replaces the valve by removing the narrowed valve and replacing it with a mechanical or biological tissue (bioprosthetic) valve. Mechanical valves, made from metal, are durable but carry the risk of blood clots forming. If you receive a mechanical mitral valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin, Jantoven), for life to prevent blood clots.

    Biological tissue valves — which may come from a pig, cow or human deceased donor — eventually need to be replaced, as they degenerate over time, particularly rapidly in younger people. Your doctor can discuss the risks and benefits of each type of heart valve with you.

If you have another condition such as coronary artery disease or atrial fibrillation, doctors may treat this at the same time your mitral valve is repaired or replaced.

Talk to your doctor about what type of follow-up you need after surgery, and let your doctor know if you develop new symptoms or if your symptoms worsen after treatment.

Less invasive procedures

Mitral valve repair or replacement generally requires open-heart surgery. Less invasive surgical techniques and procedures are being explored for mitral valve surgery and are available at some medical centers. Minimally invasive surgery should only be performed by a team of surgeons and other specialists experienced in conducting this type of procedure.

Minimally invasive heart surgery

Mitral valve repair may be conducted using minimally invasive heart surgery. Minimally invasive heart surgery is conducted through one or several small incisions in your chest. Surgical techniques include:

  • Robot-assisted heart surgery. In robot-assisted heart surgery, a surgeon uses robotic arms to duplicate specific maneuvers used in open-heart surgeries to conduct mitral valve repair.

    In this procedure, your surgeon sits at a remote console and views your heart in a magnified high-definition 3-D view on a video monitor. Your surgeon's hand movements are translated precisely to the robotic arms at the operating table, which move like a human wrist. At the operating table, a surgical team assists with the procedure and changes the surgical instruments attached to the robotic arms.

  • Thoracoscopic surgery. In thoracoscopic surgery, your surgeon inserts a long, thin tube (thoracoscope) containing a tiny high-definition video camera into a small incision in your chest. Your surgeon conducts the procedure using long instruments inserted through small incisions between your ribs.
  • Ministernotomy. In a ministernotomy, a small incision is made through the breastbone. Sometimes particular factors indicate that accessing the heart this way is the safer way to repair or replace the mitral valve.

Minimally invasive heart surgery is associated with less pain, a shorter hospital stay and fewer complications. However, the surgery is appropriate only in certain circumstances. Talk to your surgeon to see if this type of surgery might be right for you.

Catheter procedures

Several procedures using long thin tubes (catheters) to repair or replace the mitral valve have been studied and are available at some medical centers.

In one approach, an implantable clip is used to repair the mitral valve. In another procedure, doctors may use catheters to repair a leaking mechanical or bioprosthetic valve that has previously been implanted to replace the mitral valve. In this procedure, doctors insert a device into the leaking area to plug the leak.

If your bioprosthetic replacement valve is no longer working, doctors may conduct a catheter procedure to replace the valve. In this procedure, doctors insert a catheter with a balloon at the end into a blood vessel in your leg and thread it to the heart using imaging. A replacement valve is inserted in the catheter and guided to the heart. Doctors inflate the balloon in the bioprosthetic valve, and place the replacement valve inside the bioprosthetic valve. The replacement valve is then expanded.

Feb. 18, 2015
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