Your heart’s mitral valve is located between the left upper and lower chambers of your heart, and it functions as a one-way valve that ensures that blood flows in the right direction—from the lungs through the heart and into the body. It’s integral to circulation but when problems develop with this valve, they tend to do so slowly. It may be years before mitral valve problems bring noticeable symptoms.
The first sign of a mitral valve problem may be when your doctor detects a murmur (or swishing sound) while listening to your heart through a stethoscope. Maybe you’ve been feeling tired or short of breath as your heart tries to adapt to the defect’s impact on blood flow. Your feet and ankles may begin to swell. These may be signs that your mitral valve is becoming too narrow or not closing all the way after blood flows through.
“Floppy or leaky mitral valve is an underappreciated disease that can be effectively repaired by mitral valve surgeons in specialized centers like Yale,” says Arnar Geirsson, MD, a heart valve specialist and chief of cardiac surgery at Yale Medicine. “We find that patients generally experience significant improvement in symptoms following mitral valve surgery and should expect near normalization of their life expectancy,” says Dr. Geirsson.
What is the mitral valve and how does it work?
The heart constantly pumps blood throughout the body. Blood enters the heart from the lungs, coming in to the two pumping chambers on the left, called the left atrium and the left ventricle—the mitral valve helps blood flow through them. Like other heart valves, the mitral valve has “leaflets,” or flaps, that act like small gates, opening to let blood flow through and closing to keep it from flowing backward.
Problems can develop with any of the heart’s four valves, but the mitral valve is one of the most likely to require repair or replacement surgery.
Why would the mitral valve need surgery?
When the mitral valve doesn’t function properly, blood flow is inhibited, possibly leading to breathing difficulty, swelling of the leg, and irregular heart rate, which can lead to blood clots and strokes.
Mitral valve leakage, also called regurgitation, is a common diagnosis—it’s when the valve grows loose causing mitral valve prolapse (also called floppy mitral valve), allowing blood to flow backward. Another, but less common, condition is mitral valve stenosis. This is when the leaflets in the valve thicken, sometimes fusing together, preventing blood from flowing through the heart.
If possible, your doctor will try to repair your mitral valve rather than replace it. But, if there is severe damage, replacement may be required. Replacement involves implantation of the valve, using either a man-made, mechanical valve or one from animal tissue. The mechanical valve has the benefit of lasting longer but requires the patients to take blood thinning medications throughout their lives; tissue valves do not require blood thinners but will not last as long and tend to need replacement after 10 or 15 years.
What is it like to have mitral valve surgery?
A team of specialists—cardiologists, cardiac surgeons, anesthesiologists, and others—will work together to determine the best approach for your situation. You will be given general anesthesia, so you will be asleep throughout the operation.
Your operation will vary depending on the surgeon’s approach:
Open: This is the most common and “gold standard” approach, requiring a larger incision and opening the chest bone so the surgeon has direct access to the heart.
Minimally invasive: The surgeon works through an incision that is a few inches long on the right side of your chest, dividing the muscles underneath to reach the heart, sometimes utilizing cameras to assist with the operation.
Robotic: The surgeon makes one 2-inch incision and four half-inch incisions in the chest, and inserts robotic arms and tools along with a camera to provide a real-time picture of the progress.
Transcatheter: The surgeon and cardiologist can use a procedure to repair or replace the valve either through the groin or through a small incision in the chest. This technology is new and evolving, and Yale offers various innovative techniques relevant to the mitral valve.
Heart valve surgery requires use of a cardiopulmonary bypass, also known as a “heart-lung machine,” to temporarily take over the function of the heart and lungs, diverting blood from the heart so that the surgeon can operate.
Mitral valve surgery typically takes one to four hours.
How will I feel after surgery?
After heart valve surgery, patients begin their recovery in an intensive care unit, and are later transferred to a specialized care unit. They usually go home from the hospital in three to seven days.
It’s important to continue to follow up with your surgeon, who can check for any related problems that may develop, or monitor a new valve that eventually may need to be replaced.
How is Yale Medicine unique in its approach to heart valve replacement and repair?
Yale is a high-volume center for mitral valve surgery, with more of these surgeries performed at Yale New Haven Hospital (YNHH) than at any other hospital in Connecticut. Yale Medicine has the only cardiac surgery practice in New England where robotic mitral valve surgery is performed.
Yale Medicine cardiac surgeons are skilled at treating every type of valve disorder. Yale is one of the few cardiac surgery programs in the U.S. that earned three-star ratings from the Society of Thoracic Surgeons for both aortic valve and mitral valve procedures with or without concomitant coronary artery bypass procedure.
Working together with other specialists at Yale New Haven Hospital Heart & Vascular Center, Yale Medicine cardiac surgeons and cardiologists often collaborate to determine the best options for each patient, whether it’s open heart surgery, minimally invasive surgery, or transcatheter procedures.