When 'leaky' valves are at the heart of the problem

Your heart has four valves. They open during a heartbeat so that the blood can flow from one chamber to another and close to make sure that blood can’t leak back out.  

Mitral regurgitation occurs when the valve between the upper and lower chambers on the left side of the heart does not close properly. Mitral regurgitation can be caused by progressive structural changes in the leaflets of the mitral valve, certain infectious diseases and some heart attacks. 

Mitral valve prolapse is a structural abnormality of the valve where the leaflets have extra tissue and are displaced from their normal position (too far backward). A small percentage of patients with mitral valve prolapse will eventually develop regurgitation. 

Symptoms of mitral regurgitation include shortness of breath or difficulty catching your breath (especially with exertion), palpitations that feel like rapid or irregular heartbeats, and swelling of the feet and ankles. Other symptoms are weakness or dizziness, and increasing fatigue. 

An important part of the diagnosis is recent medical history. During a physical examination, your doctor may look for fluid in the lungs, an enlarged heart, or a heart murmur, which is the sound made when blood moves through a stiff or leaky valve. 

Your doctor may suggest further testing for evaluation. The test to diagnose mitral regurgitation is an echocardiogram. Sound waves are aimed at the heart allowing a detailed picture of the structure of the valves, which aids in the assessment of leaks. The strength of the heart muscle can also be assessed. Sometimes a higher resolution echocardiogram is needed to accurately assess the mitral valve. This is performed by passing a sound-generating transducer into the esophagus. This study is a TEE or transesophageal echocardiogram. 

Not all leaky valves require surgery. If the leak is mild or moderate, it is usually treated with medication and close follow-up. However, if the leak is severe, even if there are no clear symptoms, surgery is often needed. Sometimes patients who believe they have no symptoms actually do, but have adapted to their limitations. 

The only treatment currently available for severe mitral regurgitation is surgery. It is important to treat the problem before the heart has lost significant functional capacity. In most cases the valve can be repaired (in greater than 80 percent of cases). Studies show that mitral valve repair results in better long-term survival; more preservation of heart function; and lower risk of complications. 

If the valve can be repaired, no long-term use of blood thinners (anticoagulants) is required. Some valves cannot be repaired and require replacement. Whether repaired or replaced, most patients experience dramatic improvement in symptoms and functional status. Nearly all isolated mitral valve repairs or replacements can be performed using a minimally invasive approach through a 2-3-inch incision on the right side of the chest.  

Dr. Edward Savage is a cardiothoracic surgeon at Cleveland Clinic Florida. He will be among the speakers at the Cardiac Symposium on Friday. 

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