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Mitral Valve Disease

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Definition

Mitral Valve Stenosis is a condition characterized by a narrowing of the opening of the mitral valve. The mitral valve separates the upper (atria) and lower chambers (ventricles) on the left side of the heart. Stenosis or narrowing of the mitral valve prevents adequate blood flow from the atrium to the ventricle.

Mitral Valve Regurgitation (insufficiency or incompetence) is a condition in which the mitral valve does not close properly or completely, causing blood to leak back into the left atrium when the left ventricle contracts.

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Causes

Mitral Valve Stenosis

  • Rheumatic fever is the commonest cause
  • Congenital mitral stenosis as part of a complex heart deformity.
  • Tumors
  • Medications that may thicken the mitral valve.
  • Aging - deposition of calcium around the mitral valve.

Mitral Valve Regurgitation

  • Regurgitation is caused by weakening or damage to the valve following a heart attack or infective endocarditis.
  • Rheumatic Fever
  • Acute mitral regurgitation may be the result of dysfunction or injury to the valve following a heart attack or infective endocarditis. These conditions may rupture the valve, the papillary muscle or chordae tendineae (the structures that anchor the valve cusps).
  • Mitral valve prolapse
  • Congenital heart defects
  • Age related wear and tear of mitral valve

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Symptoms

Mitral Valve Stenosis

  • Difficulty breathing during or after exercise or a strenuous activity or when lying down.
  • Awakening at night with breathing difficulty
  • Cough
  • Blood streaked sputum or coughing up of blood (hemoptysis)
  • Fatigue
  • Frequent respiratory infections such as bronchitis.
  • Chest pain or discomfort
    • Which may be tight, crushing, pressure like, squeezing or constricting feeling
    • The pain radiates to the arm, neck or jaw
    • Increases with activity, decreases with rest
  • Palpitations
  • Swelling of feet or ankles
  • Fainting spells

Mitral Valve Regurgitation

  • Rapid breathing
  • Breathing difficulty that worsens when lying flat.
  • Palpitations
  • Chest pain
  • Cough with or without sputum
  • Heart murmur

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Implications

Mitral Valve Stenosis

Whatever the cause of mitral valve narrowing, the blood has to push harder to flow forward and this may cause enlargement of the left atrium. Pressure of the blood rises in the left atrium, the blood may backup in the lungs causing pulmonary congestion and pulmonary edema. This may be manifested clinically as shortness of breath and cough accompanied by blood streaked sputum. If left untreated mitral valve stenosis can lead to congestive heart failure and heart enlargement. The heart rhythm may get disturbed and chaotic (atrial fibrillation or atrial flutter). Heart valve vegetations made up of bacteria and blood components may get dislodged and travel to other parts of the body resulting in embolic complications like stroke.

Mitral Valve Regurgitation

A very serious implication of mitral valve regurgitation is infective endocarditis which is the bacterial infection of the inner lining of the heart. Severe or long standing mitral regurgitation can cause congestive heart failure or heart arrhythmias (atrial fibrillation/flutter)

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What You Can Do

Mitral Valve Stenosis

  • Medications
    • Medications like diuretics (water pills), nitrates, or beta-blockers help alleviate the symptoms of heart failure and pulmonary congestion.
    • Digoxin may be used to treat atrial fibrillation.
    • Blood thinners or anti-coagulants are used to prevent blood clots from forming and traveling to other parts of the body.
  • Surgery
    • Balloon valvuloplasty - This procedure involves passing a soft, thin tube tipped with a balloon to open up and dilate the mitral valve. The thin tube is guided through a large blood vessel in the arm or groin into the left side of your heart. Once in position at the mitral valve, a balloon at the tip of the catheter is inflated. The balloon pushes open the mitral valve and stretches the valve opening, dilating it and improving the blood flow. The balloon is then deflated and guided back, along with the catheter out of your body.
    • Mitral valve repair - This procedure called valvotomy or commissurotomy involves surgically separating, thinning or shaving back the mitral valve leaflets. This procedure can eliminate mitral stenosis and improve blood flow. Adjustments to the papillary muscles or chordae tendinae can also be done simultaneously to improve the function of the valves.
    • Mitral valve replacement - In this procedure, the mitral valve is removed and is replaced with a mechanical valve or a valve made from tissues obtained from a pig, cow or human cadaver donor. Mechanical valves which are made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. Life long use of an anticoagulant medication, such as warfarin (Coumadin), is recommended for life to prevent blood clots. Tissue valves on the other hand rarely raise your risk of blood clots. However, they tend to wear out faster than mechanical valves.
  • Lifestyle changes
    • Eat a low fat, low salt diet.
    • Always maintain a healthy weight that is appropriate for you height and age.
    • Check your blood pressure regularly.
    • Avoid caffeinated drinks. such as coffee, tea or soft drinks.
    • Avoid excessive alcohol intake.
    • Physical exercise can help keep your body fit and facilitate a speedy recovery if you ever need heart surgery.
    • Consult your physician on a regular basis for physical examination and echocardiogram to evaluate your over-all health
    • Contact your physician immediately if you experience any abnormal symptoms.
  • Prevention
    • Streptococcal throat infections should be treated promptly to prevent rheumatic fever.
    • Remind you physician to prescribe prophylactic antibiotics before any dental work, including cleaning or any invasive procedure.
    • Take the blood thinning medication on daily basis as prescribed because mitral stenosis tends to produce both cerebral and peripheral emboli (blood clots in the brain and extremities), which can cause severely disabling and life-threatening complications like stroke.

Mitral Valve Regurgitation

  • Medications
    • Antibiotics may be prescribed if there is a bacterial infection to prevent endocarditis.
    • Anti-arrhythmic's may be needed to control heart arrhythmias
    • Vasodilators or drugs that dilate the blood vessels reduce the effort of the heart in pumping blood.
    • Digitalis may be used to strengthen the heartbeat
    • Diuretics or water pills to remove excess fluid in the lungs.
    • Anticoagulants or anti platelet medications (blood thinners) to prevent clot formation and subsequent emboli.
  • Surgery
    • Mitral valve repair - In this surgical procedure the mitral valve is preserved. The surgeon modifies the mitral valve either by reconnecting the leaflets or by shaving off the excess tissue so that the leaflets of the valve can close completely and tightly.
    • Mitral valve replacement - In this procedure the mitral valve is replaced by an artificial or prosthetic valve. The artificial valves can either be mechanical or tissue valves. Life long usage of an anticoagulant medication, such as warfarin (Coumadin), is recommended to prevent blood clots from forming on the valve. Mitral valve repair or replacement generally involves open-heart surgery, done under general anesthesia. An incision is made through the length of your breastbone (sternum), your heart is exposed and connected to a heart-lung machine that assumes your breathing and blood circulation functions during the procedure. Your surgeon then replaces or repairs the valve.
  • Lifestyle changes
    • Eat a low fat, low salt diet.
    • Always maintain a healthy weight that is appropriate for you height and age.
    • Check your blood pressure regularly.
    • Avoid caffeinated drinks. such as coffee, tea or soft drinks.
    • Avoid excessive alcohol intake.
    • Physical exercise can help keep your body fit and facilitate a speedy recovery if you ever need heart surgery.
    • Consult your physician on a regular basis for physical examination and echocardiogram to evaluate your over-all health
    • Contact your physician immediately if you experience any abnormal symptoms.
  • Prevention
    • Streptococcal throat infections should be treated promptly to prevent rheumatic fever.
    • Remind you physician to prescribe prophylactic antibiotics before any dental work, including cleaning or any invasive procedure.
    • Take the blood thinning medication on daily basis as prescribed because mitral stenosis tends to produce both cerebral and peripheral emboli (blood clots in the brain and extremities), which can cause severely disabling and life-threatening complications like stroke.

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Mitral Valve Disease