The mitral valve is an important anatomical structure inside the heart. It consists of two leaflets that form a valve between the left atrium and the left ventricle.
By opening and closing the mitral valve, it is possible to control the blood flow during the cardiac cycle. It opens during filling of the ventricle and closes tightly during the ejection phase.
The valve leaflets with chordae tendineae on the papillary muscles are connected to the ventricle. This is what makes opening and closing possible in the first place.
Mitral valve reconstruction is necessary in the case of
- A leaky mitral valve (mitral valve insufficiency)
- Narrowing of the mitral valve
- Insufficient opening of the mitral valve (mitral stenosis)
With mitral valve insufficiency, the valves do not close properly. This causes the blood to flow back into the left atrium when the heart pumps. From there, it backs up into the pulmonary vessels and ultimately causes shortness of breath.
Insufficiency can be triggered by
- a mitral valve prolapse
- torn tendon threads
- a weakness in the connective tissue
- or inflammation in the heart
In mitral stenosis, on the other hand, the valve is narrowed, which means that less blood can flow into the left ventricle.
In mitral valve stenosis, the ventricular opening does not function properly due to a narrowed heart valve between the left atrium and left ventricle @ Dee-sign /AdobeStock
Common causes of such stenoses are
- age-related calcifications or
- Scarring, for example after rheumatic fever
For a time, doctors can treat the patient with medication to alleviate the symptoms of cardiac dysfunction.
The following medications are available for this purpose:
- Diuretics
- beta blockers
- Calcium channel blockers, etc.
Anticoagulation therapy with anticoagulants can also be useful to prevent the formation of thrombi.
However, drug therapies are not able to heal the defect in the mitral valve. Surgery is therefore necessary for severe insufficiencies. This is known as mitral valve reconstruction.
Various preliminary examinations are carried out before mitral valve reconstruction:
- An electrocardiogram (ECG, to monitor the heart rhythm) and
- An echocardiogram (to assess the heart structure)
In some cases, transesophageal echocardiography (TEE) may also be necessary. This involves doctors advancing an ultrasound probe down the esophagus to the level of the heart in order to take a closer look at the heart.
If the patient also has chest pain, which is typical of angina pectoris (chest tightness), a cardiac catheterization is used.
Cardiac catheterization allows doctors to assess the health of the coronary arteries more accurately.
A pulmonary function test is also usually useful, as mitral valve disease can also affect the lungs and breathing.
Patients with mitral valve disease often have difficulty breathing, so a lung function test is useful @ Viktor Koldunov /AdobeStock
Unlike artificial valve replacement, mitral valve repair involves repairing the body's own heart valve. The actual procedure can be performed in different ways.
The conventional method involves connecting the patient to a heart-lung machine and open heart surgery.
Increasingly, however, the operation is also being performed in a minimally invasive way. However, this also requires the use of a heart-lung machine.
The mitral valve reconstruction specialist will explain the various options for accessing the heart in a preliminary consultation.
It is possible to access the heart minimally invasively via a cardiac catheter or via a small incision on the side of the body.
The actual reconstruction depends on the underlying mitral valve disease:
- If the chordae tendineae are torn, correction is performed by suturing.
- However, if the leaflets themselves are affected, doctors remove the defective part and suture the healthy parts together.
- Surgeons can stabilize a mitral valve ring that has become unstable using an artificial annuloplasty ring. This must grow in and then remains in the body.
Recovery after the procedure varies greatly depending on the type of surgical procedure. As a rule, minimally invasive procedures promise faster healing.
Overall, valve-preserving mitral valve reconstruction has fewer risks than replacement with an artificial heart valve.
In particular, the risk of infection and coagulation disorders are significantly lower if the body's own mitral valve has been operated on.
An exact prognosis is only possible to a limited extent due to the many influencing factors. However, minimally invasive mitral valve reconstructions have also proven to be promising and low-risk in long-term studies:
The long-term results after mitral valve reconstruction are comparatively good: after 10 years, around 70% of patients in the studies were still alive.
Reoperations are also rare. After 20 years, the reconstructed heart valves were still functioning in more than 90% of patients.
Mitral valve reconstruction falls under the medical field of cardiac, thoracic and vascular surgery.
Mitral valve reconstruction specialists are cardiologists who specialize in cardiac surgery and work at specialized cardiac centers and in cardiac surgery departments.
Here you can find some possible specialist clinics and mitral valve reconstruction specialists in your area.