Mitral Valve Interventions: The Final Frontier
Valvular diseases, whether congenital or acquired, aren’t as serious as they used to be anymore. You can go to an interventional heart doctor in Mumbai and get it fixed. Many surgical treatment options are available when medical management is not enough, which a heart specialist doctor can perform.
The best thing is some of the new methods are non-invasive and cause minimal complications. Let’s first get to know what heart valves are and then see how interventions can fix their problems.
Heart Valves and the Function of the Heart
The heart has two sides; right and left. Each side has two chambers; an atrium and a ventricle, which make up four chambers altogether. Our right heart receives used blood from various body organs and pumps it to the lungs, where oxygenation occurs. The newly purified blood then enters the left side of the heart and is pumped once again to supply our bodily organs. On each side, the flow of blood is from the atria to the ventricles. At no point does mixing occur between the “clean” oxygenated blood from the left heart and the “used” deoxygenated blood of the right heart.
The heart valves are there to prevent the backflow of blood, especially when the pressure gradient inverts in some phases of the pumping movement of the heart. They ensure that blood flow is unidirectional and makes sure the heart does not have to exert itself unnecessarily by having to push forward the same volume of blood again and again.
There are four valves in the heart; namely mitral, tricuspid, aortic and pulmonary. The first two are called atrioventricular valves as they are situated between atria and ventricles, mitral on the left side and tricuspid on the left. The remaining two are at the ventricles’ outflow tracts, preventing backflow during times of ventricular relaxation.
What Can Cause Mitral Valve Dysfunction?
Mitral valve pathologies, or any valvular pathologies, can be broadly classified into two categories: valvular stenosis and valvular regurgitation. A valve that does not open adequately and impedes blood flow in the correct direction is said to be stenotic. On the other hand, a valve that does not close properly and allows backflow is labeled regurgitant.
Mitral regurgitation, the more common of the two, can be due to several causes. The commonest cause is mitral valve prolapse, where the mitral valve is floppy and bulges back into the left atrium when the ventricular pressure increases. It can also get damaged in pathological conditions such as rheumatic heart disease, myocardial infarctions, infective endocarditis, and cardiomyopathies. Structures called chordae tendineae that hold the valve in place can be especially damaged in heart attacks.
Mitral stenosis may occur due to calcification in old age, or maybe an outcome of rheumatic heart disease4. Both stenosis and regurgitation may occur due to congenital causes as well.
What Are the Treatment Options Available?
While mild dysfunctional states are managed medically, heart centers perform special interventions to provide lasting results and better quality of life.
In the past, the mainstay of treatment for mitral valve stenosis was commissurotomy. This surgery involves entry into the thoracic cavity and temporarily connecting the patient to a heart-lung bypass machine while the surgeon opens the narrowed valve. But now, percutaneous mitral valve balloon valvuloplasty is the preferred option by cardiology consultants. This is not an open surgical procedure. A guidewire containing an inflatable balloon is passed into the heart via a vein in the leg. Upon reaching the mitral valve opening, the balloon is slowly inflated, opening up the narrowed valve.
Surgical repair is also indicated in severe mitral valve regurgitation. It is performed in different procedures. Annuloplasty strengthens the valve and makes the opening smaller by placing a ring around the valve. Percutaneous edge-to-edge (EE) repair is an alternative low-risk option, where a clip is used to join the opposing edges of the valve. But the efficiency of this procedure is also lower than annuloplasty and associated with recurrences.
In any type of mitral valve disease, another option available is valve replacement. This is usually done as an open-heart procedure involving opening the thoracic cavity. The dysfunctional mitral valve can be replaced either using a mechanical valve or a tissue valve from an animal or a deceased person8. A heart specialist doctor will decide on this after carefully considering the pros and cons.
What should be stressed again at the end is that you don’t have to be stressed a bit about mitral valve diseases. Cardiologists at the best heart hospital in Mumbai, The Valve Clinic, are always ready and able to help you!
- Anatomy of the Human Heart – Physiopedia. Accessed August 29, 2021. https://www.physio-pedia.com/Anatomy_of_the_Human_Heart
- Anatomy and Function of the Heart Valves. Accessed August 29, 2021. https://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the-heart-valves-90-P03059
- Mitral Valve Regurgitation | Columbia University Department of Surgery. Accessed August 30, 2021. https://columbiasurgery.org/conditions-and-treatments/mitral-valve-regurgitation
- Problem: Mitral Valve Stenosis | American Heart Association. Accessed August 30, 2021. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-mitral-valve-stenosis
- Nobuyoshi M, Arita T, Shirai S, et al. Percutaneous Balloon Mitral Valvuloplasty. Circulation. 2009;119(8). doi:10.1161/CIRCULATIONAHA.108.792952
- De Bonis M, Al-Attar N, Antunes M, et al. Surgical and interventional management of mitral valve regurgitation: a position statement from the European Society of Cardiology Working Groups on Cardiovascular Surgery and Valvular Heart Disease. Eur Heart J. 2016;37(2):133-139. doi:10.1093/EURHEARTJ/EHV322
- Avanzini A, Donzella G, Libretti L. Functional and structural effects of percutaneous edge-to-edge double-orifice repair under cardiac cycle in comparison with suture repair: http://dx.doi.org/101177/0954411911414803. 2011;225(10):959-971. doi:10.1177/0954411911414803
- Mitral Valve Replacement Surgery | Michigan Medicine. Accessed September 2, 2021. https://www.uofmhealth.org/health-library/hw173544