Mitral valve regurgitation

Innovative approaches for mitral valve surgery

Our team of expert cardiologists, interventional cardiologists and cardiothoracic surgeons collaborate to develop the best treatment plan for your unique anatomy. Our clinic offers the following features:

• Advanced procedures — We offer the latest technology and minimally invasive procedures to provide options to those who were previously told that surgery is too risky.
• One convenient office visit — Whenever possible, we conduct testing, review of all results and development of a treatment plan in one, convenient office visit.
• Personalized care — We are committed to treating you the way we would treat our own loved ones. Your wants, needs and lifestyle will always be taken into account.

What is mitral valve regurgitation?

The mitral valve is the valve that separates the left atrium (upper heart chamber), which fills with blood from the lungs, from the left ventricle (lower heart chamber), which pumps and pushes blood out to the aorta.

Mitral regurgitation, or mitral valve insufficiency, is when the mitral heart valve doesn’t close completely, causing blood to flow backward into the left atrium instead of going out to the brain and other organs.

There are two types of mitral regurgitation:

• Primary MR (degenerative MR) — Degenerative mitral valve disease means that the leaflets, or flaps, of the valve are damaged or torn, due to wear and tear. Treatment options for this include open heart surgery or transcatheter mitral valve repair, using a small clip placed on your mitral valve to help it close more effectively.
• Secondary MR (functional MR) — Functional mitral valve regurgitation means that the function of the heart walls is not normal. The actual leaflet of the valve is not damaged, but the valve could be leaking because of a cardiac event such as a heart attack. This type of disease is usually treated with heart failure medication first, but you may also need a stent, a pacemaker or the clip procedure. This would be the last step before resorting to open heart surgery.

Symptoms of MR include:

• Chest pain
• Congestive heart failure
• Fainting
• Fatigue
• Heart murmur
• Heart palpitations
• Lightheadedness
• Shortness of breath
• Swelling of the legs

Minimally invasive mitral valve repair

Because they are structural issues, symptomatic moderate to severe mitral valve issues will require treatment beyond medication. Sometimes this means complex surgery will be required. These are usually open-heart surgeries that can be used to correct mitral valve regurgitation and mitral stenosis by removing the valve leak and replacing it with a mechanical or bioprosthetic valve.

However, we also offer minimally invasive mitral valve repair and replacement surgery, particularly if you are not a suitable candidate for traditional, open surgery. In these minimally invasive procedures, the breastbone does not need to be cut, and a smaller incision is made, resulting in minimal scarring and a faster recovery.

Transcatheter mitral valve repair (TMVr)

Our interventional cardiologists and cardiothoracic surgeons specialize in mitral valve repairs and replacements that place a clip on the valve to improve overall function. This catheter-based, minimally invasive procedure involves inserting a small tube into the femoral vein in the leg and advance the clip device to your heart. While your heart is beating, the doctor will position the clip at the area of the leak and grab the mitral leaflets to bring them together and reduce the leak.

If you have degenerative mitral regurgitation and are not a good candidate for open heart surgery, our heart teams may recommend TMVr with the clip. For secondary mitral valve regurgitation, the preferred treatment is usually TMVr. If you can't tolerate blood thinners or have rheumatic heart disease (thickening of the heart valve with a mix of leaking and stenosis), you probably are not eligible for TMVr. As with any procedure, there are risks that you should discuss with your cardiologist. Be sure to speak with your hospital team to make an informed decision about the treatment plan.

The transcatheter mitral valve repair results usually last more than five years. When the disease is expertly diagnosed and treated, you can experience an improved quality of life, and possibly even longer life. After the clip is placed during your procedure, you shouldn’t drive or lift anything over seven-to-10 pounds for about one week. After one week, you can get back to your normal activities. However, you'll need to remain on blood thinners for about three months. Your heart care team will give you specific follow-up instructions, but generally you will need to see your interventional cardiologist at the following milestones:

• One week after the procedure for a wound check
• One month for an echocardiogram to see how the valve is working
• Six months before going back to your general cardiologist