The mitral valve controls blood flow through the left side of the heart. When it opens, the mitral valve allows blood to flow into the left ventricle — the heart’s main pumping chamber. When the left ventricle contracts, the mitral valve closes in order to prevent blood from flowing back toward the lungs.

Sometimes the mitral valve is abnormal from birth. It can also become damaged by infection, with age or from heart disease.

What is Mitral Valve Prolapse?

If the mitral valve leaflets cannot tightly seal the left ventricle, this is called prolapse. With mitral valve prolapse, some blood flows back into the atrium – a condition called regurgitation. Regurgitation can make the heart work harder, leading to further valve damage and increasing the risk of heart failure.

Mitral Valve Prolapse Treatment Options

The treatment options available to a person with mitral valve prolapse depend on the severity of the condition. Some patients may not require any intervention. Others may be prescribed medications.

However, if your symptoms become severe, your doctor may recommend mitral valve prolapse surgery. There are two basic types of valve prolapse surgery: valve repair and valve replacement. In valve replacement, your surgeon cuts out the damaged valve and replaces it with a new, artificial valve. Valve repair involves the surgeon reconstructing your valve using your own tissues.

A new category of minimally invasive surgery, using the robotic assistance of the da Vinci® Surgical System, is rewriting the book on mitral valve prolapse surgery. Learn more about da Vinci Mitral Valve Prolapse Surgery to help determine if it is the right option for you.

Overview of Mitral Valve Prolapse

Mitral valve prolapse, is a common condition in which the mitral valve leaflets are floppy or loose. Mitral valve prolapse is diagnosed by echocardiography (EKG) which records the heart’s electrical activity. Most patients with mitral valve prolapse do not have a leaky mitral valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should be considered.

In a normal valve, the flow of blood goes from the left atrium to the left ventricle. Upon closing, it prevents blood from going back into the left atrium. With MVP the flaps fail to close evenly. One or both flaps collapse backwards, sometimes allowing a small amount of blood to leak through the valve.

Mitral valve prolapse, sometimes known as mitral insufficiency or mitral valve regurgitation, is a genetic disorder and seems to affect women three times more than men. It is one of the most common cardiac conditions.

Infection of the mitral valve or endocarditis, is extremely rare. But, people with MVP have a slightly greater risk of contracting it. 1

About the Mitral Valve

The heart has four valves that open and close to keep blood flowing in the proper direction through the heart. The mitral valve connects the heart’s upper-left chamber (atrium) to the heart’s lower-left chamber (ventricle).

Mitral valve stenosis—or mitral stenosis—is a narrowing of the mitral valve. This narrowing causes the valve to not open properly and to obstruct blood flow between the left chambers of the heart.

Mitral valve regurgitation, or mitral regurgitation, occurs when the mitral valve doesn’t close tightly and allows blood to flow backward in the heart.

Other names for mitral valve prolapse:

  • Barlow’s Syndrome
  • Floppy mitral valve
  • Myxomatous mitral valve
  • Billowing mitral valve
  • Systolic click-murmur syndrome
  • Prolapsing mitral leaflet syndrome. 2

Symptoms of Leaky Heart Valve

Many patients with mitral valve disease have no symptoms, even with a leak that is severe. When symptoms develop, they include shortness of breath, fatigue, loss of energy, swelling of the ankles and palpitations (extra or skipped heart beats).

Usually symptoms do not show up before the age of 14 or 15, but more and more children display central nervous system symptoms before the MVP shows up. Ninety-eight percent of people with Mitral Valve Prolapse Syndrome have nothing wrong with their heart. The majority of symptoms are caused by an out-of-balance nervous system. 3

Diagnosis

The first step in diagnosing mitral valve prolapse involves listening with a stethoscope. This allows the doctor to hear a murmur, which represents turbulent blood flow across an abnormal valve. The diagnosis is confirmed by an echocardiogram. Ultrasound is used in an echocardiogram which allows the doctor to visualize the heart valves and determine the severity and cause of the leak. In most patients, a standard transthoracic echocardiogram (a probe placed on the skin of the chest) is adequate to visualize the valve. Sometimes a transesophageal echocardiogram (a probe passed through the mouth into the esophagus) is necessary to more closely visualize the valve. This is an outpatient procedure.

1. “Mitral valve prolapse,” Medline Plus Medical Encyclopedia. URL: http://www.nlm.nih.gov/medlineplus/ency/article/000180.htm . See also: “Mitral valve prolapse,” MayoClinic.com. URL: http://www.mayoclinic.com/health/mitral-valve-prolapse/DS00504
2. “Mitral valve prolapse,” Medline Plus Medical Encyclopedia. URL: http://www.nlm.nih.gov/medlineplus/ency/article/000180.htm
3, Kristine A. Scordo, M.D., “Understanding the Mitral Valve Prolapse Syndrome,” www.wright.edu.

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Treatment of Mitral Valve Conditions

Most of the time, there are few or no symptoms for mitral valve conditions and treatment is not needed. But, if you have severe mitral valve prolapse, you may need to stay in the hospital. Surgery to repair or replace the valve may be needed if you have severe mitral regurgitation or your symptoms get worse. Mitral regurgitation is a condition in which your heart’s mitral valve does not close tightly, allowing blood to flow backward in your heart.

 

Commonly Prescribed Medications

Anti-arrhythmics drugs to help control irregular heart beats.
Vasodilators dilate (widen) blood vessels, which makes it easier for the heart to work.
Digitalis is used to strengthen the heartbeat.
Diuretics (water pills) help remove excess fluid in the lungs.
Propranolol is given for palpitations or chest pain.
Anticoagulants (blood thinners) help prevent blood clots in people who also have an irregular heartbeat.1

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Surgery

Surgery should be considered in virtually all patients with a leak that is graded as a 4 (severe) and in some patients with a leak that is graded as a 3 (moderately severe). When a patient with mitral valve regurgitation develops symptoms, a decrease in heart function, or an increase in heart size, surgery is recommended. Surgery should also be considered when a patient develops atrial fibrillation – an irregular heartbeat. Surgery is also recommended in many patients who don’t have any symptoms but have a severe leak; in these patients, surgery improves long-term survival.2 During surgery, a sternotomy is typically required. This is when surgeons access the heart by making an 8- to 10-inch incision down the chest, cut through the breastbone (the sternum) and open the ribs.
Minimally Invasive Surgery

Recently, minimally invasive approaches to Mitral Valve Repair are replacing sternotomy as the surgical method of choice. Of the minimally invasive approaches, robotic surgery ( da Vinci Surgery)  has many practical advantages for both the patient and the surgeon: precision, fewer complications, reduced blood loss and shorter hospital stays. According to the world-renowned Cleveland Clinic, there is a 95% chance that a leaky mitral valve can be repaired using minimally invasive techniques. 3

1. “Treatment Options for Mitral Valve Disease,” Mayo Clinic, www.mayoclinic.org. URL: http://www.mayoclinic.org/mitral-valve-disease/treatment.html
2. “Mitral Valve Repair: Answers to our most common questions,” Cleveland Clinic Heart & Vascular Institute, www.clevelandclinic.org. URL: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/valve/mvrepairfaq.htm
3. Ibid.

Surgery for Mitral Valve Repair

The best available surgical treatment for mitral valve prolapse is repair of the valve. Mitral valve repair offers a number of significant, life-long benefits as compared to valve replacement. These include a lower risk of death, a better chance of long-term survival and more freedom from future valve operations.

Potential Benefit

  • Reduced risk of surgical complications 1
  • Higher long-term survival 2, 3, 4, 5
  • Improves function and strength of the heart
  • More freedom from re-operation 6, 7
  • No need for life-long blood thinner medication
  • Shorter hospital stay

Approach for Heart Valve Repair – Alternative to Heart Valve Replacement

The most common way to repair a valve during surgery is with sternotomy – cutting through the breastbone and opening the ribs. Cutting through the body’s natural protective structure for the heart can cause significant trauma, prolong healing time and increase your risk for serious complications and even death. Moreover, this open approach doesn’t always provide surgeons with the visualization and access necessary to complete a repair. In fact, the majority of patients who undergo sternotomy receive an artificial valve8

1. Thourani VH, Weintraub WS, Guyton RA, et al. Outcomes and Long-Term Survival for Patients Undergoing Mitral Valve Repair Versus Replacement. Circulation. 2003;108:298-304 ( Emory University Atlanta )
2. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL: Valve repair improves the outcome of surgery for mitral regurgitation: a long-term study. Circulation. 1995; 91:1022-8
3. Enriquez-Sarano M, Schaff H, Frye R. Mitral Regurgitation: What Causes the Leakage Is Fundamental to the Outcome of Valve Repair. Circulation 2003;108:253-256.(Mayo Clinic Rochester )
4. Gillinov AM, Wierup PN, Blackstone EH, et al. Is Repair Preferable to Replacement for Ischemic Mitral Regurgitation? J Thorac Cardiovasc Surg 2001 Dec; 122(6):1125-41 ( Cleveland Clinic)
5. Grossi E, Goldberg J, LaPietra A, et al. Ischemic mitral valve reconstruction and replacement: Comparison of long term survival and complications . J Thorac Cardiovasc Surg 2001 Dec; 122(6):1107-24 (NYU)
6. Rodgers, E. Heart valve repair or replacement for mitral valve regurgitation or prolapse. WebMD. March 10, 2005 Bach DS. Choice of prosthetic heart valves:update for the next generation. J Am Coll Cardiol. 2003 Nov 19;42(10):1717-9.
7. Ruel M, Kulik A, Rubens FD, Bedard P, Masters RG, Pipe AL, Mesana TG. Late incidence and determinants of reoperation in patients with prosthetic heart valves. Eur J Cardiothorac Surg. 2004 Mar;25(3):364-70.
8. Society for Thoracic Surgeons & Duke Clinical Research Institute. Executive Summary. STS Fall 2005 Report.

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da Vinci® Mitral Valve Repair

If your doctor recommends surgery to treat mitral valve prolapse, you may be a candidate for da Vinci® Mitral Valve Repair, potentially the most effective and least invasive treatment option available.

da Vinci Mitral Valve Repair is an alternative to conventional open heart surgery – the traditional way to treat mitral valve disease. da Vinci Mitral Valve Repair is performed using the da Vinci Surgical System, enabling your surgeon to operate with unparalleled precision and control through a few small incisions.

da Vinci can help your surgeon repair your valve and help you avoid mitral valve replacement. With valve replacement, your natural valve tissues are cut away and replaced with an artificial valve. This is important because a repair can provide you with many significant advantages as compared with mitral valve replacement, including: no need to take life-long blood thinners, less need for future valve operations 1,2, reduced risk of surgical complications 3, a higher long-term survival rate 4, 5, 6 and improved heart function4.  A recent study suggests that the da Vinci System may allow surgeons to complete 50% more repairs than they can when using an open surgical approach. 7

In addition to avoiding the pain and trauma of sternotomy (cracking open the breastbone to access the heart) and rib spreading, da Vinci Mitral Valve Repair may provide patients with the following benefits over open surgery:

  • Less risk of infection
  • Less blood loss and need for blood transfusions
  • Shorter hospital stay
  • Significantly less pain and scarring
  • Faster recovery
  • Quicker return to normal activities
  • And a potentially better clinical outcome

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While da Vinci Mitral Valve Repair is considered safe and effective, it may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

1. Rodgers, E. Heart valve repair or replacement for mitral valve regurgitation or prolapse. WebMD. March 10, 2005  Bach DS. Choice of prosthetic heart valves:update for the next generation. J Am Coll Cardiol. 2003 Nov 19;42(10):1717-9.
2. Ruel M, Kulik A, Rubens FD, Bedard P, Masters RG, Pipe AL, Mesana TG.  Late incidence and determinants of reoperation in patients with prosthetic heart valves. Eur J Cardiothorac Surg . 2004 Mar;25(3):364-70.
3. Thourani VH, Weintraub WS, Guyton RA, et al.  Outcomes and Long-Term Survival for Patients Undergoing Mitral Valve Repair Versus Replacement.  Circulation . 2003;108:298-304 ( Emory University Atlanta )
4. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL: Valve repair improves the outcome of surgery for mitral regurgitation: a long-term study. Circulation. 1995; 91:1022-8
5. Gillinov AM, Wierup PN, Blackstone EH, et al. Is Repair Preferable to Replacement for Ischemic Mitral Regurgitation? J Thorac Cardiovasc Surg 2001 Dec; 122(6):1125-41 ( Cleveland Clinic)
6.  Grossi E, Goldberg J, LaPietra A, et al.  Ischemic mitral valve reconstruction and replacement:  Comparison of long term survival and complications.  J Thorac Cardiovasc Surg 2001 Dec; 122(6):1107-24 (NYU)
7. 96.2% received a repair with da Vinci Surgery, as reported by Douglas Murphy, MD, compared to 60% of patients in the Fall 2005 Sternotomy database, where 42,000 out of 70,000 received a replacement. See Society for Thoracic Surgeons & Duke Clinical Research Institute. Executive Summary. STS Fall 2005 Report. Murphy D, Smith M, Siwek L, Langford D, Robinson JR, Reynolds B,  Seshadri-Kreaden U, Engel A. Multicenter Mitral Valve Study: a Lateral Approach using the da Vinci Surgical System. Pending publication. Data on file with Intuitive Surgical, Inc.
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

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