Mitral Valve Disease

OVERVIEW

Mitral valve which is also known as the bicuspid valve is one of the heart’s four valves. Located on the left side of the heart, it helps prevent blood from flowing backward when it moves through the heart. It’s when the mitral valve does not work properly; one suffers from mitral valve disease. When the mitral valve does not work properly, blood flows backward into the left atrium. Due to this, the heart loses the ability to pump enough blood out of the left ventricular chamber to supply the body with oxygen-filled blood. Main symptoms caused by heart valve disease are shortness of breath and fatigue. But there are many people who do not experience any symptoms for the disorders of mitral valve.
Mitral valve disease, if it is left untreated can leave a person with serious life-threatening complications like heart failure and irregular heartbeats, called arrhythmias.

TYPES OF MITRAL VALVE DISORDER

Mitral Valve Regurgitation: When regurgitation of mitral valve happens, the leaflets of the mitral valve do not close too tightly. This causes the blood to leak from the valve and to flow backward into the left atrium of the heart. It can mainly result in heart muscle damage if it is not treated in time. Regurgitation can also be caused by the prolapsed mitral valve, where the leaflets bulge back into the left atrium when the heart contracts.
Mitral valve stenosis:  Stenosis happens when the flaps of the mitral valve become narrow, thick or stiff and may not fuse together. And this finally results in a narrowed valve opening with the blood flow from the left atrium to the left ventricle getting reduced.

CAUSES

The scarring from rheumatic fever can cause mitral valve stenosis. Rheumatic fever is generally a childhood disease and it results from the body’s response to the infection from streptococcal bacteria. Rheumatic fever affects the joints and the heart mostly. As the joints become inflamed, it can often lead to chronic disabilities and also to the inflammation of various parts of the heart.
There are also certain other causes of mitral valve stenosis but they are very rare in nature.  Few of the causes include calcium buildup, tumors, congenital heart disease, and blood clots.
The mitral valve not closing properly can cause mitral regurgitation. This can happen if the ring of muscle around the valve has become too wide, or the mitral valve has become too floppy. All these problems tend to develop with age due to the wear and tear or because of the damage caused by untreated high blood pressure. Mitral valve prolapse can also sometimes cause mitral regurgitation.

COMPLICATIONS

Blood clots and gel-like clumps can be caused by severe regurgitation. It can further end up creating serious problems if they enter the brain or lungs. Fluid can build up in the lungs causing strain to the right side of the heart. Very less blood goes to the body if you’re suffering from regurgitation; your heart has to work harder to make up for the shortfall. If this condition continues, there’s a chance that the heart becomes enlarged and pumping blood becomes even more difficult, leading to the risk of a complete heart block.

SYMPTOMS

Symptoms of the mitral valve disease entirely depend on the exact issue that you have with the valve. There may be no symptoms at all for some people, but when symptoms occur they may include shortness of breath, especially when you are doing any strenuous physical activity or exercising, fatigue, cough and also lightheadedness. There will be tightness or pain in the chest and in some people they might feel the heart beating rapidly or irregularly. All the symptoms of mitral valve disease develop gradually. The symptoms may show or get worse if you engage in any activity that deals with stress. Heart palpitations also happen when the heart skips a beat and produces a sensation that feels like pounding to fluttering. It may happen when you are lying on your left side.

 DIAGNOSIS

The unusual sounds or different rhythm patterns help your doctor in finding out if you have mitral valve disease. The doctor can listen to these sounds through a  stethoscope and it helps them in finding out what’s going on. There may be certain tests that you may have to undergo to help confirm if you have mitral valve disease.

• Chest X-ray:  This is a common test that produces images on a film or computer by sending X-ray particles through the body.   It helps the doctor in finding out if the heart is enlarged, indicating certain types of heart valve disease.
• Echocardiogram (ECG): Ultrasound waves are used in this test to produce images of the heart’s function and structure. ECG can also help detect enlarged chambers of the heart, abnormal heart rhythms and also heart disease.
• Exercise tests: There are different exercise tests that help in measuring the tolerance of the activity done by a person and also monitoring the heart’s response to certain physical exertions.
• Cardiac MRI: Magnetic fields and radio waves are used by MRI to create detailed images of the heart. The test is generally used to determine the severity of a person’s condition.
• Cardiac catheterization: In this procedure, there are a variety of tests done which includes an image of the heart’s blood vessels. A long thin tube is inserted into the arm, neck, upper thigh and it is threaded to the heart.

TREATMENT

Treatment for mitral valve disease entirely depends upon how severe the condition is or if the condition is getting worse or if the person is experiencing symptoms of the disease. A cardiologist can help provide care and the right treatment for the same. If one has mitral valve disease, they may be evaluated and treated by specialists who treat heart valve disease. There will be regular monitoring of the condition with regular follow up appointments. The doctor may recommend certain lifestyle changes and prescribe medications to treat symptoms.

 Medications: Although some medications can bring relief and ease the symptoms or prevent them from getting worse, there are no specific medications that can actually cure the structural issues with the mitral valve. Only if the doctor thinks that the treatment is necessary, he/she may start treating you with medications. Medications prescribed may include anticoagulants to thin the blood, beta blockers to help slow heart rate, and the treatment of arrhythmias.
If your condition is mild, the doctor will suggest monitoring the condition with regular evaluations. Medications will be prescribed to manage the symptoms and if one suffers from the mild condition, surgery may not be advised.
But if the doctor considers that the mitral valve has to be repaired or replaced, he/she may advise mitral valve repair or mitral valve replacement. Several studies prove that performing surgery in a person, who has severe valve regurgitation but has no symptoms,  rather than just monitoring the condition, can help improve long term outcomes. In cases, where heart valve surgeryof another condition is present, in addition to the mitral valve disease, doctors will conduct surgery for both the conditions so that both can be treated at the same time.
Most of the doctors prefer and recommend mitral valve repair but if mitral valve repair is not possible they may opt for mitral valve replacement. Doctors also evaluate the candidates to find out if they are a good candidate for open-heart surgery or invasive heart surgery.
Also Read About: Transcatheter Aortic Valve Replacement
Women who suffer from mitral valve disease have to discuss with the doctor before they conceive. The doctor can help them with the medications that can be safely taken and also whether a procedure is required to treat the valve condition before the pregnancy. Close monitoring of health is also required during pregnancy.

Mitral Valve Repair

Mitral valve repair would be advised by your doctor as it helps preserve your heart valve and also preserve heart function. In this surgery, holes will be patched in a valve to reconnect the valve flaps and also to separate valve leaflets that have fused together. The cords will be replaced that support the valve or the excess valve tissues will be removed as the leaflets can close tightly. The ring around a valve may be also tightened or reinforced by implanting an artificial ring.

Mitral valve replacement

Mitral valve replacement may be advised if the mitral valve cannot be repaired. In the mitral valve replacement, the damaged valve is removed and then it gets replaced with a mechanical valve or a valve that has been made from pig, cow or human heart tissue also called biological tissue valve. Over a time period, biological tissue valves have the tendency to degenerate and will need to be replaced. People who have mechanical valve placed will be required to take blood thinning medications for a lifetime so that blood clots can be prevented. Before the surgery, the doctor will share the benefits and risks of each type of valve and also educate which of the valves is appropriate for a person.
MANAGING THE CONDITION
There are certain things a person can do to manage the condition of mitral valve regurgitation at home.

• Medication: Although medication may not directly stop the regurgitation, but can help in reducing the other issues causing it, such as bringing down high blood pressure. The instructions given by your doctor should be followed properly and one needs to discuss with the doctor if there are any side effects.
• Eating a healthy and balanced meal: One needs to eat a lot of fruits and vegetables, and proteins and also limit the intake of salt. Limiting sugar, saturated and trans fats is also advisable.
• Regular physical activity: Following a daily or weekly exercise regimen is good for managing different types of heart disease. Take the advice of your doctor before starting any kind of exercise.
• Quit smoking: If you are into regular smoking, it is better to quit smoking. Your doctor can help you quit smoking or else you can join a support group who will help you to quit smoking.
• Stress management: Coping with stress in a healthy way is quite important to manage the disease. Stress can sometimes trigger chest pain and also heart attack in many people.
• Maintaining a healthy weight: One should ways to maintain or reach a healthy weight with the help of the doctor. The doctor may advise suitable exercises to help stay fit. But the exercise regimen should be accordingly to the present condition, as certain vigorous exercises may cause certain symptoms to flare up.
• Visit the doctor regularly:  Keeping up regular appointments with the doctor treating should on top priority as it will help manage the disease and conditions in a better manner.