The mitral valve is one of the four valves in your heart. It regulates blood flow between the two chambers on the left side of your heart. When your mitral valve doesn’t work correctly, problems with blood flow can damage your heart.
The heart surgery specialists at Central Maine Heart & Vascular Institute have expertise in all types of heart valve surgery, including mitral valve surgery. Patients with mitral valve hardening (stenosis) or leakage (regurgitation) are candidates our for minimally invasive surgical treatment.
About the Mitral Valve
The mitral valve is a valve in the heart located between the left atrium and the left ventricle. It allows blood to flow from the left atrium into the left ventricle, but not in the reverse direction. The mitral valve has two flaps (cusps). It is also known as the bicuspid valve.
There are two types of mitral valve disease:
- Mitral valve stenosis: This occurs when the flaps of the mitral valve stiffen, thicken or stick together. When this happens, the valve opening gets smaller and less blood can flow from the left atrium to the left ventricle.
- Mitral valve regurgitation: This occurs when the flaps of the mitral valve can no longer close completely and tightly. When this happens, blood leaks back into the left atrium from the left ventricle. Over time, this leakage, or regurgitation, can damage your heart muscle.
Symptoms of Mitral Valve Disease
Mitral valve disease may have no symptoms, or it could cause the following:
- Anxiety
- Chest pain or discomfort
- Dizziness
- Fatigue
- Heart palpitations or irregular heartbeat
- Shortness of breath
Over time, mitral valve disease can lead to dangerous complications such as blood clots, stroke, heart failure, irregular heartbeat (atrial fibrillation) and pulmonary hypertension (high blood pressure that affects the blood vessels in the lungs).
Minimally Invasive Mitral Valve Surgery
Open-chest valve surgery has been used successfully in the surgical treatment of various heart-circulatory problems for decades. However, minimally invasive surgical treatment is now a preferable option for many patients. These surgeries are performed with high-tech thin instruments, miniature cameras and hybrid techniques.
Minimally invasive valve surgery techniques offer several advantages compared to open-chest procedures. They include:
- Faster recovery. Patients can usually return to work or other activities within two or three weeks, which is much quicker than open-chest heart valve surgery.
- Shorter hospital stays. Hospitalization time can be reduced by as much at 50%.
- Fewer complications. Because the breastbone (sternum) is not cut during minimally invasive surgery, chances for post-surgical complications and infection go down.
- Less pain. Decreased trauma to tissue and muscle results in less pain than open-heart procedures.
- Less blood loss. Because incisions are smaller, patients lose less blood and are less likely to require a transfusion.
- Less scarring. Only a few tiny scars and/or a two-inch scar remains after minimally invasive valve surgery.
If you have minimally invasive mitral valve surgery, your surgeon will make four or five dime-size incisions in your upper chest between our fourth and fifth ribs or through a two-inch incision on the side of your chest. Using specialized surgical equipment and cameras, your surgeon performs the surgery much as they would through a far larger incision through the breastbone (sternum).
During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon removes the damaged valve and sews a new valve in place. The replacement valve may come from an organ donor, but it is more likely to be a mechanical valve made of plastic and metal. Sometimes diseased valves can be repaired – for example, if calcium deposits on the valve can be removed, the valve may be surgically reshaped, allowing it to close more effectively. If the valve opening is too big, it sometimes can be tightened with stitches.
If you are not a candidate for minimally invasive mitral valve surgery, CMHVI also offers conventional open chest surgery.
Mitra Clips
In the past, open-heart surgery was the only option for patients with damaged heart valves. Now transcatheter mitral valve replacement with MitraClip® therapy offers a minimally invasive alternative for patients who don’t qualify for traditional surgery.
Why Do You Need a MitraClip?
Every heart has four chambers that collect blood and circulate it throughout the body. Heart valves play an important role in this process — they open to allow blood to empty through a chamber and close so blood cannot flow the wrong way.
Mitral regurgitation is a common heart valve problem that occurs when blood leaks backward when the left ventricle contracts. Blood flow in both directions causes increased blood volume and pressure, which can lead to the following symptoms:
- Chest pain
- Loss of consciousness
- Shortness of breath
- Swelling in the lower body
Although symptoms can range from mild to more severe, regurgitation could cause serious complications and eventually lead to heart failure. If you have severe mitral regurgitation and have not responded to other medical therapy, a MitraClip procedure could help repair the damaged heart valve and improve your quality of life.
Getting Ready for a MitraClip
Speaking with your surgeon and medical team before receiving a MitraClip procedure can help you feel confident before surgery. They will provide you with preparation instructions to follow for up to a week before surgery. Those instructions could include the following:
- Keep the area to be operated on clean to prevent infection.
- Do not consume any food or liquids the night before surgery.
- Pick up any prescribed pain medications or antibiotics.
- Stop certain medications temporarily. Your provider will advise you about medications that need to be discontinued.
Preparing your home in advance will also make coming home after surgery easier. Having premade meals, a well-stocked pantry and a clean house can help you relax after your operation and focus on healing.
What to Expect During a MitraClip Procedure
During a MitraClip procedure, the surgeon guides a catheter from a vein in the leg to reach the heart. A small, metal clip is inserted onto the flaps of the mitral valve to hold it together. The clip stays inside the body to keep the valve together and stop blood leakage backwards toward the lungs.
Recovering From MitraClip
Because MitraClip placement is a minimally invasive procedure, most patients have a faster recovery time, less pain and not as much blood loss as conventional surgery.
Patients usually stay in the hospital for three days or fewer. When you are ready to return home, you will be given instructions about taking care of the incision and what medications you should take for pain. To reduce swelling, it may be recommended that you keep your legs elevated or wear elastic stockings. Your provider will give you detailed guidelines about when to resume normal activities.
Sources: fda.gov, heart.org, heart.org, heart.org, heart.org, medlineplus.gov, medlineplus.gov, medlineplus.gov, nih.gov, nih.gov, sts.org