Mitral Valve Prolapse and Heart Valve Repair
Fall 2006
Like Mr. Boyer, millions of
Americans are affected by mitral
valve prolapse (MVP), the most
common heart valve problem
diagnosed in the United States.
The mitral valve allows blood to
flow in one direction between two
chambers of the heart — the left
atrium (upper chamber) and the left
ventricle (lower chamber). Normally,
the mitral valve closes after blood
flows through it. However, a person
with MVP has a valve flap that does
not close or seal properly and bulges
backwards (prolapse) into the upper
chamber.
MVP is usually detected with a
stethoscope during a routine physical
examination. Most people diagnosed
with MVP are born with the condition
and do not experience any symptoms.
However, some people may feel
occasional heart palpitations, chest
pain, shortness of breath, dizziness or
anxiety. Occasionally, people with
MVP may need to take antibiotics
before surgery or dental work to
prevent infection.
Minimally Invasive Heart Valve Repair
In most cases, MVP does not
affect a person’s health and does not
require any treatment. However,
approximately two out of every
100 people with MVP develop
complications due to mitral valve
regurgitation (MR). Mitral valve
regurgitation occurs when blood
flows or “leaks” back into the left
atrium thereby decreasing blood flow
to the body. Symptoms may develop
gradually if the heart is able to
compensate for the valve defect;
however, sometimes the disorder
develops quickly along with severe
symptoms, which could lead to
serious problems such as congestive
heart failure, stroke, irregular
heartbeat, progressive damage to the
heart muscle or sudden death.
When mitral valve regurgitation
is present, the heart valve may need
to be surgically repaired or replaced.
Valve repair or replacement
traditionally requires open-heart
surgery using a heart-lung machine,
also called cardiopulmonary bypass.
Heart-lung machines perform several
critical functions during surgery,
particularly re-routing oxygenenriched
blood away from the heart
to the brain and other vital organs
while the surgical team is working
on the patient’s heart. Traditional
open-heart surgery also requires a
large chest incision approximately
11 or 12 inches in length in order to
reach the heart.
At Pennsylvania Hospital, patients
who are eligible or prefer bloodless
surgical techniques are offered
alternative options to traditional
open-heart surgery. At the Center for
Bloodless Medicine and Surgery,
highly skilled surgeons use minimally
invasive surgical techniques to
repair heart valves, most commonly
the mitral valve for leaking or
regurgitation or the aortic valve for
narrowing or stenosis. Not everyone
is a candidate for this surgery. For
example, patients may not be eligible
if they are obese, high-risk elderly
patients or have atherosclerosis, also
called hardening of the arteries. In
addition, minimally invasive surgery
is the best option for someone
experiencing a single valve problem
as opposed to multiple problems.
The concept behind minimally
invasive valve repair is the same as
open-heart surgery, but with distinct
advantages. Minimally invasive
surgery uses much smaller incisions,
approximately 2 inches in length, to
enter the chest and reach the heart.
The breastbone is not divided and
the surgical team uses the heart-lung
machine in different ways than
traditional surgery. The advantages
of minimally invasive heart surgery
include limited blood loss, fewer side
effects from the smaller incision, less
scarring, better cosmetic results, a
shorter hospital stay and faster
recovery.
If you are diagnosed with a heart
valve problem related to mitral valve
regurgitation or other complications,
talk with your physician about which
surgical option is right for you. If
you are not eligible for minimally
invasive valve surgery, traditional
open-heart surgery is available using
bloodless techniques.
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