Heart - Cardiology & Cardiovascular Surgery

Mitral Valve Disease and Diagnosis

The human heart has four valves (flaps made of tissue) that control the direction of blood flow. Normal valves act like a system of one-way doors, ensuring that blood flows in one direction through the heart chambers. The aortic and mitral valves are part of the left side of the heart and control the flow of oxygen-rich blood from the lungs to the body, while the pulmonic and tricuspid valves are part of the right side of the heart and control the flow of oxygen-depleted blood from the body to the lungs.

The mitral valve opens when the left ventricle relaxes (called diastole), allowing blood from the left atrium to fill it. When the left ventricle contracts (systole), the increase in pressure within the ventricle causes the valve to close, preventing blood from leaking into the left atrium and assuring that all of the blood leaving the left ventricle (the stroke volume) goes out to the body. For the valve to function properly, there must be proper interplay between the annulus, leaflets, and subvalvular apparatus.

If the mitral valve does not close completely, it can cause regurgitation, which causes blood to leak back into the left atrium. If the valve does not open completely, it can cause stenosis, which can obstruct blood flow. Both conditions increase the workload on the heart and are very serious conditions. If left untreated, they can lead to debilitating symptoms including arrhythmia, congestive heart failure, and irreversible heart damage.

Detection and Diagnosis

If you have leakage through your mitral valve, you might feel fatigued, find it difficult to exercise, or experience shortness of breath or palpitations. Symptoms might come and go. We usually get a hint that there is a valve issue when we listen to your heartbeat. We might hear a murmur, which would either sound like a ‘whooshing’ noise or an extra click, depending on the type of problem.

To diagnose heart valve disease, we do a physical exam and conduct imaging tests. At the exam, your cardiologist will check for fluid build-up and will use imaging tests such as echocardiograms, chest X-rays, transesophageal echocardiograms, and cardiac catheterizations.

The latest literature has demonstrated the positive impact (better postoperative long-term survival) of early mitral valve repair, rather than waiting for symptoms such as ventricular dysfunction or dilatation, pulmonary hypertension, or atrial fibrillation—the standard guideline triggers for surgery in previous eras. However, the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA) for the management of patients with valvular heart disease recommend early mitral valve repair only if the procedure is performed in a mitral valve reference center. The Mitral Valve Repair Reference Center at The Mount Sinai Hospital is among the world’s best.

Mitral Valve Repair Vs. Replacement

The ACC/AHA Guidelines recommend mitral valve repair over replacement, particularly with degenerative disease. The advantages to mitral valve repair over replacement are: a significantly lower perioperative risk, improved preservation of left ventricular function, enhanced survival, and less prosthesis-related complications. At the Mitral Valve Repair Reference Center at The Mount Sinai Hospital, we repair nearly all prolapsing valves.