Mitral Valve Repair - Specialists and Information

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.

The opening and closing of the mitral valve allows for the regulation of blood flow during the cardiac cycle. It opens during ventricular filling and closes tightly during the ejection phase.

The valve leaflets, connected to the papillary muscles by chordae tendineae, are attached to the ventricle. This is what makes the opening and closing possible in the first place.

Mitral valve reconstruction is necessary in the following cases:

• A leaky mitral valve (mitral regurgitation)
• Narrowing of the mitral valve
• Insufficient opening of the mitral valve (mitral stenosis)

In mitral valve regurgitation, the valves do not close properly. This causes blood to flow back into the left atrium as the heart pumps. From there, it backs up into the pulmonary vessels and eventually causes shortness of breath.

Causes of insufficiency may include:

• mitral valve prolapse
• torn chordae tendineae
• weak connective tissue
• or inflammation in the heart

In mitral stenosis, on the other hand, the valve is narrowed, which restricts the flow of blood into the left ventricle.

In mitral valve stenosis, the opening between the left atrium and the left ventricle does not function properly due to a narrowed heart valve @ Dee-sign /AdobeStock

Common causes of such stenoses include:

• age-related calcifications or
• scarring, such as that caused by rheumatic fever

For a time, doctors can treat patients with medication to alleviate the symptoms of heart dysfunction.

The following medications are available for this purpose:

• Diuretics
• Beta-blockers
• Calcium channel blockers, among others

Anticoagulation therapy with blood thinners may also be beneficial to prevent the formation of blood clots.

However, drug therapies cannot cure the defect in the mitral valve. In cases of severe insufficiency, surgery is therefore necessary—specifically, mitral valve reconstruction.

Various preoperative examinations are performed before mitral valve reconstruction:

• An electrocardiogram (ECG, to monitor heart rhythm) and
• An echocardiogram (to assess the heart’s structure)

In some cases, a transesophageal echocardiogram (TEE) may also be necessary. During this procedure, doctors advance an ultrasound probe through the esophagus to the level of the heart to examine it closely.

If the patient also has chest pain typical of angina pectoris (chest tightness), a cardiac catheterization is performed. 

A cardiac catheterization allows doctors to more accurately assess the health of the coronary arteries. 

A pulmonary function test is also generally recommended, as mitral valve disease can also affect the lungs and breathing.

Patients with mitral valve disease often have difficulty breathing, which is why a pulmonary function test is recommended @ Viktor Koldunov /AdobeStock

Unlike artificial valve replacement, mitral valve reconstruction involves repairing the body’s own heart valve. The actual procedure can be performed in various ways.

The conventional method involves connecting the patient to a heart-lung machine and performing open-heart surgery.

However, the surgery is increasingly being performed using a minimally invasive approach. Even in this case, the use of a heart-lung machine is still required.

The mitral valve reconstruction specialist will explain the various options for accessing the heart during a preliminary consultation. 

It is possible to access the heart minimally invasively via a cardiac catheter or through 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, the defect is repaired by suturing. 
• If, on the other hand, the valve leaflets themselves are affected, doctors remove the damaged portion and suture the healthy portions together. 
• Surgeons can stabilize a mitral valve annulus that has become unstable using an artificial annuloplasty ring. This ring must integrate with the surrounding tissue and remains in the body.

Recovery after the procedure varies greatly depending on the type of surgical technique used. Generally, minimally invasive procedures promise a faster recovery.

Overall, valve-preserving mitral valve reconstruction carries fewer risks than replacement with an artificial heart valve. 

In particular, the risk of infection and coagulation disorders is significantly lower when the body’s own mitral valve is operated on.

An accurate 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 outcomes following mitral valve reconstruction are comparatively good: After 10 years, approximately 70% of the 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 within the medical field of cardiac, thoracic, and vascular surgery.

Specialists in mitral valve reconstruction are cardiologists with a subspecialty in cardiac surgery. They work at specialized heart centers and in cardiac surgery departments. 

Here you will find a selection of specialized clinics and mitral valve reconstruction specialists, including those near you.