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The heart is a mechanical marvel—a construction of pumps, tubes and valves that keep blood flowing in the right directions at the right times. As with any machine, though, parts can wear out. One of the most common “weak links” is called the mitral valve, the “inflow valve” for the left side of the heart. Repairing this valve once required major open surgery to implant a synthetic valve.
Now, though, cardiac surgeons often can repair the existing valve through minimally invasive techniques, an alternative that better preserves function and long-term health. “Repair is always preferable to replacement,” says David Spielvogel, M.D., Program Director, Heart Transplantation, at Westchester Medical Center. “Replacement valves are never as good as repairing the existing tissue to remedy degenerative mitral-valve disease.
Also, there is no age limit; repair can be performed even for patients in their 70s and 80s.” To understand the importance of this valve, we need a quick anatomy lesson. Blood flows from the lungs, where it picks up oxygen, into the left atrium. The mitral valve then opens to allow blood to flow from the left atrium. The valve then closes to keep blood from leaking back into the atrium and the lungs. Most mitral-valve disease is degenerative. “Sometimes it causes little difficulty, and people can function well with it, even athletes,” Dr. Spielvogel says. “But changes can take place, and a small subset of people with the disease develop problems.”
The disease can soften the valve and make it too loose, which allows the blood to flow backward toward the lungs. This can produce symptoms such as shortness of breath, fatigue and palpitations, but the condition may require mitral-valve surgery whether or not symptoms appear. “Without repair, patients have a lower life expectancy,” says the doctor. “But repair restores a normal predicted life span.”
Minimally invasive mitral-valve surgery is done through surgical cuts much smaller than the ones used in open surgery. The repair is generally straightforward and requires only three to four days’ recovery in the hospital. “The techniques are very mature and have been refined so that more than 98 percent of these valves can be repaired with excellent results,” says the doctor. “Recovering patients need a few weeks to get their energy back, but once they’ve healed there’s no restriction on their activities.”
Dr. Spielvogel should know. Not only is he a mitral valve surgeon, he is also a patient. “I had mine repaired in 2006,” he says.
Related Read: Surgery on a Tiny Scale
