Mitral Valve Stenosis
Surgery
If medicines are not effective in controlling your symptoms of mitral valve stenosis or if your doctor determines that you need more aggressive treatment, you may need surgery to repair or replace your mitral valve. While valve surgery is common and usually successful, a degree of risk is associated with this invasive procedure. There are generally three options: a balloon valvotomy, a closed (or open) commissurotomy surgery, or valve replacement surgery.
Valve repair (balloon valvotomy)
Balloon valvotomy (percutaneous mitral balloon valvotomy) is the method of choice for treating mitral valve stenosis in select patients. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, so recovery is easier.
A balloon valvotomy is usually recommended if you have symptoms, moderate to severe stenosis, and most of your mitral valve is a normal shape.2
Your doctor will measure your pressure gradient and valve size to determine how bad the stenosis is. A normal mitral valve has an opening between 4 cm2 and 5 cm2.
A balloon valvotomy may also be used to treat people with mitral valve stenosis who do not yet have symptoms (asymptomatic) if they have:2
- A higher risk of dangerous blood clots (thromboembolism). This includes people with an irregular heart rhythm called atrial fibrillation, as well as those who have had a blood clot before.
- High blood pressure in the lungs (pulmonary hypertension).
- Mitral valves that are still in fairly good condition.
Your doctor may recommend a balloon valvotomy if you are planning to have another surgery (not on your heart), if you are pregnant, or if you are planning a pregnancy.
People with signs of blood clots in the left atrium, widespread calcification of the mitral valve structures, or moderate to severe mitral valve regurgitation are not considered good candidates for a balloon valvotomy.2
The mitral valve may narrow again (restenosis) after 10 to 20 years.
Valve surgery
Depending on the amount of damage to your mitral valve, your doctor may recommend surgery to repair or replace your mitral valve. If the valve is damaged beyond repair, it will need to be replaced. Mitral valve surgery may be done as an open-heart surgery, or a minimally invasive surgery.
During open-heart surgery, your heartbeat is stopped, and you are placed on a heart-lung machine to deliver blood to your body. The heart-lung machine temporarily serves in place of your heart and lungs by mixing oxygen with the blood, removing carbon dioxide from the blood, and pumping the blood throughout your body.
During minimally invasive surgery, your doctor makes a smaller incision than the incision made in open-heart surgery. You may still be placed on a heart-lung machine. Valve repair or replacement is similar for minimally invasive surgery and open-heart surgery.
Valve repair
In open commissurotomy, a surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.
Valve replacement
The damaged heart valve is removed and replaced with a new valve. This is generally done when your mitral valve is damaged beyond repair. With improved technology, mitral valve replacement is an important surgical option. Some doctors believe that replacement mitral valves are now more durable. In addition, more of the original mitral valve and its support structure (such as the chordae tendineae) are preserved during valve replacement. The long-term results of surgery are generally better when more of the original mitral valve structure is preserved.
Replacement heart valves
There are two types of replacement valves:
- A mechanical heart valve is made from plastic or metal. It is more likely to cause blood clots in the heart that can travel to the brain and cause a stroke. Because of this danger, people who have a mechanical heart valve must take anticoagulant medicine for the rest of their lives. This medicine prevents blood clots from forming.
- A bioprosthetic heart valve is made from human or animal (usually pig) tissue. In most people, it has the advantage of not requiring medicine to prevent blood clots. But bioprosthetic valves are not as sturdy as the mechanical valves. They usually need to be surgically replaced after about 10 years. Bioprosthetic valves are usually inserted in people older than 70.
Most people who have mitral valve replacement surgery will receive a mechanical heart valve. Even if a bioprosthetic tissue valve is used, you will need to take anticoagulants if you also have other heart conditions such as abnormal heartbeat (arrhythmia) or a dilated left atrium, because both of these conditions are risk factors for stroke.
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| Author: | Robin Parks, MS | Last Updated: March 18, 2008 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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