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Mitral Valve Incompetence

Mitral valve incompetence, which is also referred to as mitral valve regurgitation or insufficiency, occurs when the two leaflets of the mitral valve no longer meet each other when the valve is closed. Because the leaflets do not meet, some of the blood that should be ejected into the aorta is squeezed through the faulty mitral valve backwards into the left atrium as the left ventricle contracts. The resulting higher pressure in the left atrium sends blood backwards into the lungs. The heart also has to work harder because some of the blood that’s being pumped is going backwards. As a result, the left ventricle will dilate and begin to fail.

Causes:

  1. Congenital birth defect of the mitral valve, infective endocarditis, and coronary artery disease (this is called ischemic mitral regurge due to inadequate blood supply of the muscles controlling the function of the valve).
  2. Myxoid degeneration, in which some of the tissues in the heart are weakened, and the valve is prone to incompetence. This condition can affect varying parts of the mitral valve. For example, the chordae, which attach the valve to the underlying muscles, can rupture.
  3. Sometimes mitral incompetence occurs suddenly due to rupture of papillary muscles as a result of heart attack or as a complication of a procedure called balloon mitral valvotomy. In both cases the condition of the patient is bad and requires emergency surgery.

Symptoms and signs:

  1. Chronic weakness and fatigue.
  2. Shortness of breath, cough and sometimes coughing blood.
  3. In severe sudden cases, shortness of breath is much worse and the condition may require mechanical respirator to help you breathing.
  4. On examination, your doctor can listen to a murmur over your heart.

Diagnostic Tests: To diagnose and determine treatment for your particular valve disease, your doctor will obtain a complete medical history, perform a thorough physical exam and order any or all of the following special diagnostic tests:

Chest x-ray – X-rays can provide doctors information about the size of your heart (enlarged in this case) and its four chambers, as well as information about your lungs (congested).

Electrocardiogram (EKG) – This test records the changes of electrical activity occurring during your heartbeat. Atrial fibrillation is a common finding.

Echocardiogram (echo) – This test uses ultrasound to examine and measure the structure of your heart. An echo demonstrates performance of the mitral valve and the cause behind mitral incompetence as well as information on heart muscle function.

Cardiac catheterization (coronary arteriogram) – This test allows visualization of your blood vessels and measurement of pressures inside your heart chambers following injection of a contrast dye. It is usually performed if you are 40 or above. If your coronary arteries have significant blockages, your cardiac surgeon will perform coronary artery bypass surgery at the time of your valve surgery.

Treatment:

Mitral  valve incompetence initially may be treated medically using diuretics and anti heart failure medications but, in most cases, surgery is necessary to repair or replace the damaged valve. Your surgeon will determine which procedure is best for you, taking into consideration your age, medical history, the nature of your heart disease, your lifestyle and your ability to take anticoagulants (medications that prevent your blood from clotting).

There are three main classifications of artificial valves:

  1. Bioprosthetic valves are from animals treated with chemicals to avoid rejection.
  2. Mechanical valves are made of metal, carbon and/or synthetics. Anticoagulation is required to prevent blood clots.
  3. Biologic valves are human heart valves obtained from donors after death and frozen for later use (homograft).

Some valves can be surgically repaired to help them open or close more efficiently. Two common surgical repair procedures are:

  1. Ring Annuloplasty, which is a procedure in which the annulus, or ring like part of the valve, is tightened by placing a ring of metal, cloth or tissue around the valve.
  2. Valve Repair, which is a procedure to reconstruct the leaflets, chordae, and/or papillary muscles of the valve.

 

 

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