17240 Mitral Valve Repair

Overview

Your heart has four valves that work like one-way doors, opening and closing to keep blood flowing the right way. The mitral valve sits between the upper and lower chambers on the left side of your heart. Sometimes this valve stops closing tightly, so blood leaks backwards. Mitral valve repair is an operation to fix that valve and help it close properly again. The surgeon keeps your own valve and reshapes or tightens it, rather than replacing it with an artificial one. Repair is often preferred when it is possible, because keeping your own valve usually means fewer long-term medicines and a lower risk of infection.

Yes. Mitral valve surgery is one of the more common heart operations worldwide. Repair is used more and more often, and in many centres it is now the first choice for a leaking mitral valve when the valve can be fixed.

It can affect adults of any age, but it is most often done in middle-aged and older adults. The most common reason is a mitral valve that leaks because of a stretched or floppy valve (called mitral valve prolapse). Some younger adults and, rarely, children need repair because of a valve problem they were born with or damage from an infection.

Symptoms

Common symptoms

• Feeling short of breath, especially when walking fast, climbing stairs or lying flat
• Unusual tiredness or low energy during everyday activity
• A fluttering, pounding or racing feeling in the chest (palpitations)
• Swollen ankles, feet or legs, or bloating in the belly
• A heart murmur — an extra sound your doctor hears through a stethoscope
• Dizziness or light-headedness
• Waking up at night feeling breathless

Symptoms in children

• Many children have no symptoms at all and the problem is found during a routine check
• Tiring quickly during play or sport compared with other children
• Poor feeding and slow weight gain in babies
• Fast breathing or sweating during feeds
• Frequent chest infections or being smaller than expected for their age

Symptoms in older adults

• Breathlessness that slowly gets worse over months, often put down to 'just getting older'
• More tiredness and less ability to do usual activities
• Swelling in the legs and weight gain from extra fluid
• An irregular heartbeat, which is more common with age
• Confusion or poor sleep if the heart is struggling

Causes

Main causes

• Mitral valve prolapse — the valve flaps are floppy and stretch back, so they do not close tightly
• Wear and tear of the valve as part of ageing
• Rheumatic heart disease — lasting damage after a throat infection with strep bacteria that was not treated
• Infection of the heart valve (endocarditis)
• A valve problem you were born with
• Damage to the heart muscle from a heart attack or a weakened heart (cardiomyopathy), which stretches the valve ring

Risk factors

• Getting older
• A family history of valve problems or mitral valve prolapse
• Previous rheumatic fever or untreated strep throat
• Previous infection of a heart valve, or conditions that raise infection risk such as injected drug use
• Heart attack or long-standing high blood pressure
• Some connective tissue conditions that affect the body's support tissues
• Previous chest radiotherapy

When to see a doctor

See a doctor urgently if:

• New or worsening breathlessness, especially at rest or lying flat
• Swelling in the legs or belly that is getting worse
• Chest pain, fainting or a racing heartbeat
• Fever with no clear cause — particularly if you have a known valve problem

Book a routine appointment if:

• You are more tired than usual or get breathless with activities you used to manage easily
• Your doctor has heard a heart murmur and wants it checked
• You have a known valve problem and your follow-up appointment is due
• You have questions about surgery, recovery or returning to work and exercise

Diagnosis

Doctors usually start by listening to your heart, asking about your symptoms and checking your blood pressure and pulse. If they suspect a valve problem, they will arrange a scan of your heart. An echocardiogram (an ultrasound scan of the heart) is the key test — it shows how the valve moves, how much blood leaks backwards and how well your heart is pumping. You may also need blood tests and other heart tests to plan whether surgery is right for you and when to do it.

Tests that may be done

• Echocardiogram — an ultrasound scan that shows the valve and heart muscle in motion
• Transoesophageal echocardiogram — a closer scan done with a thin tube passed gently down the throat, sometimes used before surgery
• Electrocardiogram (ECG) — a tracing of your heart's electrical rhythm
• Chest X-ray — a picture of the heart's size and the lungs
• Blood tests — to check your general health and how well your heart is coping
• Exercise or stress test — to see how your heart responds to activity
• Cardiac catheterisation — a procedure using a thin tube to look at the heart's arteries, sometimes needed before surgery
• Heart monitor worn at home — to pick up an irregular heartbeat

What to expect at your appointment

Most tests are quick and painless. An echocardiogram feels like a normal ultrasound — cool gel and a probe on your chest. You may have a few appointments over several weeks. Your heart team will then meet to discuss your case and talk you through the options, including the risks and benefits of repair, replacement or waiting and watching.

Treatment

Treatment depends on how severe the valve problem is, whether you have symptoms and how well your heart is pumping. Some people are safely watched with regular scans for years. When the valve needs fixing, surgery to repair your own valve is often the best option. If repair is not possible, the valve may be replaced instead. Your heart team will explain which approach suits you.

Self-care at home

• Stop smoking — this is the single biggest thing you can do to help your heart and your recovery
• Keep active within what feels comfortable, and ask your team about a cardiac rehabilitation programme
• Eat a balanced diet and keep salt moderate to help with fluid build-up
• Weigh yourself regularly if your team asks you to, and report fast weight gain
• Look after your teeth and gums, and see a dentist regularly — healthy gums help protect heart valves from infection
• Take your medicines as prescribed and do not stop them without asking your doctor
• Go to your follow-up scans even if you feel well

Medical treatments

There is no medicine that repairs a damaged valve. Medicines are used to ease symptoms and protect the heart — for example, tablets that remove extra fluid, tablets that lower blood pressure and help the heart pump more easily, and medicines to steady an irregular heartbeat. Some people also need treatment to prevent blood clots. If you have an irregular heartbeat, your doctor may suggest a procedure to restore a normal rhythm. Your GP, pharmacist and heart team will work together to get the right combination for you and review it regularly.

When is surgery considered?

Surgery is usually considered when the leak is severe and either you have symptoms, or tests show your heart is starting to enlarge or weaken even though you feel well. Repair is usually done before the heart muscle is permanently damaged, which is why regular scans matter. Surgery may also be advised if the valve is narrowed and causing symptoms. Many repairs are done through a smaller cut, and some are done using keyhole or robot-assisted techniques. For some people who are too frail for open surgery, a less invasive option using a thin tube through a vein in the leg may be offered. Your team will discuss what is realistic and safe for you.

Living with this condition

At first, recovery is slow and steady. In the first few weeks you will tire easily and may need help with shopping, cooking and housework. Your breastbone usually takes about 6 to 8 weeks to heal, so avoid heavy lifting and pushing or pulling with your arms during that time. Most people are driving again after a few weeks, once they can move comfortably and concentrate — check with your surgeon and your insurance. Many people return to lighter work after 6 to 8 weeks. Gentle walking is encouraged from early on, and cardiac rehabilitation gives you a safe plan to build up strength.

Lifestyle tips

• Build activity up gradually and follow the plan your team gives you
• Avoid heavy lifting and strenuous arm work while your chest heals
• Keep up good dental care and tell your dentist about your valve repair
• Stay up to date with your follow-up scans and appointments
• Limit alcohol and avoid smoking
• Ask your team before starting vigorous sport, saunas, hot tubs or air travel

Diet and exercise

Eat a varied, balanced diet with plenty of vegetables, fruit, wholegrains, beans and fish, and choose healthier fats. If you are retaining fluid, your team may suggest keeping salt lower — ask for advice rather than cutting salt out completely. Regular gentle exercise such as walking helps your heart and mood. A cardiac rehabilitation programme is the safest way to get back to fitness, because it is tailored to you and supervised by people who know your heart.

Mental health and emotional wellbeing

It is very common to feel anxious before heart surgery and low in mood afterwards. Some people have vivid dreams, trouble sleeping or feel teary for a few weeks. This usually settles, but it is worth talking about. Tell your GP or heart team if you feel persistently low, worried or unable to cope — support such as counselling or a rehabilitation group can really help. If you ever feel you cannot keep yourself safe, contact your local emergency number or a crisis line in your country straight away.

Prevention

Not all valve problems can be prevented, especially those you are born with or those caused by ageing. But you can lower your risk of some causes and protect your heart. Treating strep throat properly with antibiotics, keeping blood pressure and cholesterol in a healthy range, not smoking, staying active and looking after your teeth and gums all help. If you already have a valve problem, good follow-up and timely treatment prevent damage from getting worse.

Vaccines

Keep up with routine vaccinations, including flu and pneumonia vaccines if your doctor recommends them. Infections put extra strain on the heart, and preventing them is a simple way to protect yourself. Ask your GP or pharmacist which vaccines suit you.

Screening programmes

There is no general screening programme for mitral valve disease. If you have a heart murmur, a family history of valve problems or a connective tissue condition, your doctor may arrange an echocardiogram. Once a valve problem is known, regular echocardiograms are the main way to check it and decide the right time for treatment.

Complications

If left untreated

• The heart muscle can stretch and weaken, leading to heart failure
• Fluid can build up in the lungs and legs, causing breathlessness and swelling
• An irregular heartbeat such as atrial fibrillation can develop
• High blood pressure in the lungs (pulmonary hypertension)
• Higher risk of infection of the valve
• In rare cases, a higher risk of stroke

Long-term outlook

For most people, mitral valve repair works well. Many notice easier breathing and more energy within a few months, and repairs tend to last for many years. Some people need further surgery eventually, which is why follow-up scans matter. Modern heart teams are very experienced at matching the right operation to the right person, and there is good support to help you through recovery. If you have questions or worries at any point, ask your team — that is what they are there for.

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