Pictures of mitral valve: Mitral Valve Photos and Premium High Res Pictures

21.02.197617.10.2021 by alexxlab

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Mitral Valve Repair Surgery Pictures

This deserves a “Wow!”

I could ramble on about how neat this is… Instead, I’ll simply let Geoff explain. Here is Geoff’s email:

Hi Adam,

I am home from my surgery!!

The mitral valve repair was performed last Tuesday morning. I left Duke Medical Center, five days later, on Saturday morning at 9:45 am!

I am fairly weak and somewhat sore. But, overall I am doing great. I spent the first night after heart surgery in the intensive care unit (ICU). The breathing tube and TEE were removed in the first few hours after surgery. I had tubes coming out of me from many places – an IV in my neck, left arm artery, left arm near elbow and right arm.

Geoff’s Diseased Mitral Valve Before Surgery

I can’t say enough good things about the staff at Duke Medical Center. My surgeon, Doctor Donald Glower, was able to repair the valve so that there was 0% mitral regurgitation. If you are interested, I have attached the before and after pics. (To learn more about mitral regurgitation, click here.)

Geoff’s Mitral Valve After Heart Valve Repair – 0% Regurgitation

Thank you for your heart valve book, and all the blog members, for their stories and insight. Heart surgery truly is an emotional journey. My fiancee, Lisa, and I are very happy to be through it.

Thanks… Geoff

Written by Adam Pick

– Patient & Website Founder

Written by Adam Pick – Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient’s Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Pictures of Regular & Diseased Heart Valves

I’ll never forget my second opinion from Dr. Chaikin, a cardiologist in Los Angeles.

I was having my second echocardiogram…

Unlike many cardiologist, Dr. Chaikin was actually present during the echocardiogram. He studied the monitor as it flashed pictures of my beating heart and pictures of my heart valves. I studied the monitor as well – with great purpose and intent. But, I had no idea what I was looking for.

As it turns out, eight weeks later I would find myself having double heart valve replacement surgery via the Ross Procedure. Similar to most patients, I became much, much, much, much, much more interested in heart valve anatomy once I scheduled my open heart surgery with Dr. Vaughn Starnes.

One of the questions I had was, “What does a heart valve really look like?”

I knew my bicuspid aortic valve was a congenital defect. But, I didn’t really understand the impact of having two leaflets versus three leaflets. That said, I started looking for heart valve pictures.

Guess what? I found not one heart valve picture but many heart valve pictures! Scroll below to understand exactly what a heart valve looks like!

First, you should probably see a human heart diagram to understand how the valves are located in the heart. In this diagram of the heart, you see the aortic valve, the mitral valve, the pulmonary valve and the tricuspid valve.

As you can see, most heart valves have three leaflets, while the mitral valve only has two leaflets.

Now let’s take a look at a real heart valve picture from an actual human heart. This heart valve picture shows a heart valve with severe heart valve disease. The valve cusps are rigid and deformed due to the calcification of the heart valve. So you know this is the aortic valve. This is one of the reasons I needed to have heart valve surgery. To learn more about calcified valves, click here.

Here is a heart valve picture of a heart valve suffering from mitral valve prolapse. In this heart valve diagram, you will note the blood falls back through the heart due to the improper functioning of the mitral valve. This is mitral valve regurgitation also known as a leaky heart valve. To learn more about MVP, click here.

Keep on tickin!
Adam

Written by Adam Pick

– Patient & Website Founder

Written by Adam Pick – Patient & Website Founder

Mitral Valve Repair

Overview

Mitral Valve Repair at Cleveland Clinic

At Cleveland Clinic we have the world’s greatest experience with mitral valve repair, the best option for most patients with a leaking mitral valve (mitral regurgitation).

Our surgeons have special expertise in mitral valve repair. As a consequence, at Cleveland Clinic, nearly all leaking mitral valves are repaired rather than replaced. A repair rate of nearly 100% for patients with leaking mitral valves provides patients with ideal outcomes. And for those with isolated mitral valve problems, the majority of operations are performed robotically or minimally invasively, ensuring rapid recovery.

In 2019, patients traveled to Cleveland Clinic from all 50 states and 103 countries for their cardiovascular care.

What are the symptoms of a leaking mitral valve?

Many patients with mitral valve disease are asymptomatic (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).

How is a leaky mitral valve diagnosed?

The first step involves listening with a stethoscope. Using a stethoscope, the doctor hears a murmur, which represents turbulent blood flow across an abnormal valve. The diagnosis is confirmed by an echocardiogram. Ultrasound is used in an echocardiogram to allow 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.

What is 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. Most patients with mitral valve prolapse do not have a leaky valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should be considered.

Mitral Valve Prolapse

What are the indications for surgical repair of a leaking mitral valve?

Surgery should be considered when the leak is severe. In most facilities, the regurgitation (leak) is graded on a scale from 0 to 4, with 0 being no leak and 4 being a severe leak.

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 regurgitation develops symptoms, a decrease in heart function, or an increase in heart size, surgery is nearly always recommended. Surgery should also be considered when a patient develops atrial fibrillation, which is an irregular heartbeat. Surgery is also recommended in most asymptomatic patients who have a severe leak. In asymptomatic patients with severe mitral regurgitation, surgery improves long-term survival. In contrast, waiting for the development of symptoms or changes in heart function can leave patients with permanent heart damage.

What is the chance that a leaky mitral valve can be repaired?

Nearly 100%. The most common cause of mitral regurgitation is a condition called degenerative mitral valve disease—this is also called mitral valve prolapse, myxomatous mitral valve disease, and a floppy mitral valve. Such valves can be repaired (rather than replaced) in more than 95% of patients. Cleveland Clinic heart surgeons have the world’s largest experience with mitral valve repair.

What is the chance that a leaky mitral valve can be repaired minimally invasively?

Approximately 60-80%. When a patient requires isolated mitral valve surgery for a degenerative valve, at Cleveland Clinic we can perform the operation through a 2 to 4 inch skin incision in in the majority of cases. Preoperative testing enables us to choose the safest approach for each patient. We offer several different minimally invasive approaches, including a small incision on the right chest, a small incision in the mid-line, and robotically assisted procedures. Expertise with several approaches enables us to determine the best procedure for each patient, optimizing results.

Procedure Details

Minimally Invasive Mitral Valve Repair

Cleveland Clinic surgeons are pioneers in the development of minimally invasive techniques for mitral valve repair. Today, the majority of isolated mitral valve repairs can be performed through a 2-3 inch incision on the right side of the chest. In many cases, we can employ the surgical robot and limit incision size to 1 inch.

Full Sternotomy

Partial Sternotomy

Right Thoracotomy

Robotic

Several minimally invasive approaches are available to patients. Minimally invasive approaches may also be used for patients who require aortic valve or tricuspid valve surgery, alone or in combination with mitral valve surgery. In addition, Cleveland Clinic is a leader in percutaneous (through the skin) approaches to mitral valve repair, which may lead to additional treatment options in the future.

Advantages of minimally invasive approaches include faster recovery, less pain, reduced need for blood transfusion and better cosmetic result. We evaluate each patient for robotic and minimally invasive surgery and work with the patient to choose the best and safest approach in each case.

Learn about minimally invasive mitral valve repair: types of incisions, surgical options, photos and videos.

Mitral Valve Repair Surgery — Surgical Techniques

Cleveland Clinic surgeons have been instrumental in the development and application of modern mitral valve repair techniques. Problems with the posterior leaflet are generally corrected by a small series of chords or a small resection of the abnormal portion of the valve. Anterior leaflet dysfunction is managed by creation of new chords or chordal transfer. Anterior leaflet repair techniques are technically challenging, requiring a skilled and experienced surgical team to achieve the best result. All repairs include an annuloplasty, which is a complete or partial ring placed around the circumference (rim) of the valve.

Mitral Valve Posterior Leaflet Prolapse — Valve Repair Surgery

During mitral valve repair heart surgery, triangular resection is the technique used most frequently for posterior leaflet prolapse.

Triangular Resection Mitral Valve Repair

Ruptured chords at free edge of posterior leaflet. Region to be resected is indicated.

Abnormal segment has been removed. Leaflet edges are sewn together.

Annuloplasty completes the repair.

Mitral Valve Anterior Leaflet Prolapse — Valve Repair Surgery

When there is mitral valve prolapse of the anterior leaflet, repair is more complex and requires greater surgical expertise. To correct anterior leaflet prolapse caused by a ruptured or elongated chord, we usually create new chords out of Gore-Tex. These Gore-Tex chords generally last forever. A second technique used for correction of anterior leaflet prolapse is chordal transfer, which involves transfer of chords from another part of the valve to the area with abnormal chords. Both techniques provide excellent long-term results for patients.

Gore-Tex® Chord for Correction of Anterior Leaflet Prolapse

Ruptured Chord

After Chordal Repair

Chordae may be constructed from Gore-Tex® sutures. A Gore-Tex® suture is affixed to the head of the papillary muscle and then passed through the free edge of the unsupported anterior leaflet, providing support.

Long-term durability is excellent. The new chordae do not rupture or elongate.

Chordal Transfer to Treat Anterior Leaflet Prolapse

Chordal transfer to correct anterior leaflet prolapse.

Posterior leaflet chordae are transferred to the unsupported free edge of the anterior leaflet. The posterior leaflet is then repaired. A cloth annuloplasty band completes the repair.

Mitral Valve Repair — Special Situations

Mitral Valve Repair and Atrial Fibrillation

Many patients with mitral valve disease have atrial fibrillation, (an abnormal heart rhythm.) For these patients, at the time of mitral valve repair, Cleveland Clinic surgeons perform an ablation (Maze procedure) with the intent of curing the atrial fibrillation. In some patients with atrial fibrillation, a sternotomy (standard) approach may provide the best results.

Previous Mitral Valve Repair with Recurrent Mitral Regurgitation

In rare instances, a mitral valve repair may fail over time. While most surgeons replace such valves, Cleveland Clinic surgeons can frequently re-repair these valves, offering excellent long-term durability and the important advantages that go with mitral valve repair.

Previous Heart Surgery with Recurrent Mitral Regurgitation

Occasionally, a patient who has had previous bypass surgery, aortic valve surgery or other heart surgery develops a new problem with the mitral valve. In these re-operative settings, Cleveland Clinic surgeons can safely and effectively repair nearly all leaking mitral valves.

Mitral Valve Repair for Endocarditis

When infection damages a mitral valve (endocarditis), repair is particularly challenging. Because of their extensive experience with such patients, Cleveland Clinic surgeons successfully repair the mitral valve in the majority of patients who have had endocarditis.

Mitral Calcification

Occasionally, a patient with mitral regurgitation has extensive calcium deposits on the valve leaflets or annulus. The calcium makes repair difficult and requires application of advanced surgical techniques and sound judgment. Cleveland Clinic surgeons have the expertise to ensure excellent outcomes in patients with calcified mitral valves.

Mitral Valve Repair in Women with Breast Implants

We can usually perform a minimally invasive approach in women with breast implants. Working with a plastic surgeon, we remove the right breast implant through a small, cosmetic incision We then repair the mitral valve through the same incision. The plastic surgeon then replaces the breast implant, often upgrading to a newer implant.

Risks / Benefits

Your Heart Valves

Advantages of Mitral Valve Repair: Why Repair Is Better Than Replacement

Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant) mitral valve and for many with a narrowed (stenotic) mitral valve.

Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners (anticoagulants). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair, when possible.

Advantages of Mitral Valve Repair:

Better early and late survival (Longer life!)
Improved lifestyle
Better preservation of heart function
Lower risk of stroke and infection (endocarditis)
No need for blood thinners (anticoagulation)

Your Mitral Valve

Mitral Valve Chordae and Papillary Muscles

What is the risk of mitral valve surgery?

For asymptomatic patients having mitral valve repair, the operative risk is approximately 1 in 1000. Risk in symptomatic patients remains well under 1%. The presence of coronary artery disease or other conditions that require surgical treatment will affect your individual risk. Ask your doctor about your surgical risk.

What is the durability of a mitral valve repair?

After mitral valve repair, 95% of patients are free of reoperation at 10 years, and this figure is approximately 90% at 20 years. Thus, reoperation is uncommon after a successful mitral valve repair. An echocardiogram is recommended annually to assess valve function. In addition, patients who had valve surgery must take steps to prevent infection and reduce the risk of endocarditis (an infection of the valve).

Why is it important to have my surgery at a center with a large experience in mitral valve repair?

Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant) mitral valve and for many with a narrowed (stenotic) mitral valve.Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually avoids the need for long-term use of blood thinners (anticoagulation). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair.

Advantages of Mitral Valve Repair

Better early and late survival
Improved lifestyle
Better preservation of heart function
Lower risk of stroke and infection (endocarditis)
No need for blood thinners (anticoagulation)

Mitral valve repair is more challenging than mitral valve replacement, and experienced surgeons are more likely to be able to repair the valve and ensure an excellent outcome.

Resources

Doctors who treat

Cleveland Clinic has the nation’s largest valve treatment program.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

Cleveland Clinic Heart, Vascular & Thoracic Institute Cardiologists and Surgeons

The following Mitral Valve Center surgeons specialize in mitral valve surgery:

*Performs robotically assisted mitral valve surgery

The Mitral Valve Center surgeons offers expertise and experience to provide the best outcomes possible.

Departments and Sections:

Choosing a doctor to treat your heart valve disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with Heart Valve Disease:

Department of Thoracic and Cardiovascular Surgery: Surgeons in the Department of Thoracic and Cardiovascular Surgery are experts in the treatment of valve disease, including valve repair or replacement, minimally invasive heart valve surgery, and re-do operations depending on the individual needs of the patient. For surgical review or more information, call toll-free 877.843.2781 (877-8Heart1) 6 a.m. – 9 p.m. EST, Monday – Friday or request an appointment online.

Department of Cardiovascular Medicine: Heart valve specialists in the following sections provide evaluation, medical management and life-long care of patients with heart valve disease:

Call Cardiology Appointments at toll-free 800.223.2273, extension 4-6697 or request an appointment online.

Considering traveling to Cleveland Clinic for heart surgery?

If you need a heart operation, you want the best surgeon with the best team at the best hospital. But traveling to the nation’s best hospital for heart surgery is more comfortable and convenient than you might think.

Need a second opinion?

Virtual Second Opinions connect you online with top Cleveland Clinic specialists who can review your diagnosis and offer additional consultation, quickly and securely.

Contact

To obtain a surgical consultation, or if you have additional questions or need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

B

ecoming a Patient

Conditions

Treatment Guides

Diagnostic Tests

Diagnostic tests are used to diagnose your valve disease and the most effective treatment method.

Anatomy

Questions and Answers

Our webchats transcripts provide questions and answers to quesitons about

valve disease and treatment.

Videos and Podcasts

Interactive Tools

Resource Links

The inclusion of links to other websites does not imply any endorsement of the material on those websites nor any association with their operators.

Surgical Outcomes

Why choose Cleveland Clinic for your care?

Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.

Anatomy of the mitral valve: understanding the mitral valve complex in mitral regurgitation | European Heart Journal – Cardiovascular Imaging

Abstract

Imaging the mitral valve requires an understanding of the normal anatomy and how this complex structure is altered by disease states. Mitral regurgitation is increasingly prevalent. Despite the fall in rheumatic diease, it is the second most common valvular lesion seen in adults in Europe. In this review, the morphology of the normal and abnormal valve is reconsidered in relation to the key structures, with a view to aiding the reader in understanding how this might relate to echocardiographic identification of abnormalties.

Introduction

Imaging the mitral valve (MV) requires an understanding of the normal anatomy and how this complex structure is altered by disease states. The MV is composed of several structures working in synchrony to open during diastole and close in systole effectively within the high-pressure systemic environment. Morphological changes of the valve can affect mechanical integrity resulting in abnormal leaflet closure and regurgitation of blood back into the left atrium causing loss of ventricular pressure and forward flow.

Mitral regurgitation is increasingly prevalent. Despite the fall in rheumatic diease, it is the second most common valvular lesion seen in adults in Europe.¹ Surgical repair should be performed whenever possible when the likelihood of successful repair is high. Since retaining the native valve has significant advantages, including the preservation of left ventricular function and long-term survival.² In this review, the morphology of the normal and abnormal valve is reconsidered in relation to the key structures with a view to aiding the reader in understanding how this might relate to echocardiographic identification of abnormalties.

Normal mitral valve anatomy

Leaflets

The MV comprises two leaflets, annular attachment at the atrioventricular junction, tendinous chords and the papillary muscles (PMs). The two leaflets of the MV are noticeably different in structure and are referred to as the anterior and posterior leaflets by clinicians. Although neither description is anatomically correct, the terms aortic and mural leaflets are preferred.³ The mural (posterior) leaflet is narrow and extends two-thirds around the left atrioventricular junction within the inlet portion of the ventricle. In adults, the mural leaflet has indentations (sometimes called ‘clefts’) that generally form three scallops (segments) along the elongated free edge. These indentations do not usually extend all the way through the leaflet to the annulus; if this is seen, then this is usually associated with pathological valve regurgitation. Carpentier’s nomenclature⁴ describes the most lateral segment as P1, which lies adjacent to the anterolateral commisure, P2 is central and can significantly vary in size, and most medial is P3 segment, which lies adjacent to the posteromedial commissure (Figure 1).

Figure 1

Specimen picture showing the base of the heart with the location of two- and four-chamber echocardiographic views superimposed (double-headed arrows). (1) Base of the adult heart specimen showing the mitral valve with double-headed arrows superimposed demonstrating the two- and four-chamber echocardiographic approach. Δ, anterolateral commissure; ▴, posteromedial commissure; A1–A3, divisions of the aortic mitral leaflet; P1–P3, divisions of the mural leaflet of the mitral valve; LAA, left atrial appendage; PT, pulmonary trunk; NC, non-coronary cusp of the aorta; LCC, left coronary cusp of the aorta; RCC, right coronary cusp of the aorta.

Figure 1

The semicircular aortic (anterior) leaflet of the MV is much broader than the mural leaflet, comprises one third of the annular circumference and has a clear and rough zone (Figure 2). The distinguishing feature of this leaflet is the fibrous continuity with the left and non-coronary cusps of the aortic valve and with the interleaflet triangle between the aortic cusps that abuts onto the membranous septum.⁵ The aortic leaflet is also divided arbitrarily into three regions labelled A1, A2 and A3 corresponding to the adjacent regions of the mural leaflet (Figure 1).

Figure 2

(A) The aortic leaflet of the mitral valve is in fibrous continuity with the leaflets of the aortic valve, this comprises the clear zone of the leaflet. The undersurface of the rough zone in this mitral leaflet has many cordal attachments. (B) The mural leaflet of the mitral valve has a basal zone (bracket) which inserts into the annulus at the left atrioventricular junction (arrow).

Figure 2

From the attachment point of each leaflet at the annulus to the free edge, the leaflet is described as having basal, clear and rough zones (Figure 2). The basal zone is described as the area where the leaflet connects to the atrioventricular junction. The thin central portion of the leaflet is the clear zone. The thick rough zone at the free edge of the leaflet is the main area of chordal attachment and the region of coaptation (i.e. where the leaflets meet) and apposition (overlap of the leaflet free edge).

Annulus

The term annulus is used to described the junctional zone which separates the left atrium and left ventricle, this also gives attachment to the mitral valve. It is not a rigid fibrous ring but pliable, changing shape during the cardiac cycle. Instead, it incorporates several structures along its hinge point (see Histology section). The annulus, which demarcates the leaflet hinge line, is of oval shape, the commissural diameter being larger than the anteroposterior diameter (i.e. through A2 and P2). The aortic valve is in fibrous continuity with the aortic mitral leaflet (anterior) and the right and left fibrous trigones.⁶ This region of the annulus is thus fibrous and less prone to dilatation. Beyond this point, the remaining two-thirds of the annulus are mainly muscular. In significant mitral regurgitation, this region is often seen to dilate, as well as being more prone to calcification.

Chordae tendinae

In the normal valve, the leaflets have fan-shaped chords running from the papillary muscles and inserting into the leaflets. Depending on where they attach, there are three types of chordae tendinae. Primary chords attach to the free edge of the rough zone of both leaflets. Secondary chords attach to the ventricular surface in the region of the rough zone (i.e. body of the leaflet). The tertiary chords are found in the mural (posterior) leaflet only which has a basal zone. These chords attach directly to the ventricular wall (Figure 3).⁷ The posteromedial PM gives chords to the medial half of both leaflets (i.e. posteromedial commissure, P3, A3 and half of P2 and A2). Similarly, the anterolateral PM chords attach to the lateral half of the MV leaflets (i.e. anterolateral commissure, A1,P1 and half of P2 and A2). Among the secondary chords of the aortic (anterior) leaflet, there are two that are the largest and thickest. Termed strut cords, these arise from the tip of each papillary muscle and are thought to be the strongest.

Figure 3

View of the ventricular surface of an adult mitral valve. The chords extend not only from the free edge of the leaflet to the papillary muscles but also from the ventricular surface. This difference in chordal attachement, such as the stabilizing strut chords connecting the ventricular surface to the papillary muscles, demonstrates that the thickness and morphology of the leaflet varies from the annular attachment to the free edge.

Figure 3

Papillary muscles

The PM bundles are generally described in anterolateral and posteromedial positions and are positioned along the mid to apical segments of the left ventricle. The former is usually seen to attach at the border of the anterolateral (lateral) and inferolateral (posterior) walls, and the latter over the inferior wall of the left ventricle and in the majority of adults the PM can have up to three heads.⁸ However, we have observed that this distribution can vary significantly, particularly, in patients with myxomatous-type leaflets (degenerative MV disease). In some cases, one or both PMs are undefinable and replaced with multiple small muscle bundles attaching to the ventricular wall (Figure 4).

Figure 4

Papillary muscle head orientation and distribution. Transthoracic 2D images: left image shows the normal arrangement of the two papillary muscles (most inferior is the posteromedial). The right image shows multiple small heads scattered around the ventricular wall, neither papillary muscle can be clearly defined. This patient has a prolapse of several segments of both leaflets.

Figure 4

Histology of normal mitral valve leaflets

The adult mitral leaflet contains distinct atrialis, spongiosa, fibrosa and ventricularis histological layers.⁹ Each layer comprises extracellular components including interstitial fibroblasts and connective tissue fibres. Three types of collagen are present in the leaflet, primarily type I collagen at 74%, with type III collagen consisting of 24% and type V collagen at 2%.¹⁰ The fibrous tissues, along with elastic fibres, are integrated together within a ground substance and are covered by a layer of endothelial cells. The endothelial layer of cells is continuous with the luminal surface of the atrium and the ventricle.

The atrialis is the uppermost layer adjacent to the left atrium. It is composed of mainly aligned elastic and collagen fibres covered with overlying endothelium. Beneath the atrialis is the spongiosa layer which largely consists of an extracellular matrix, or ground substance, of proteoglycans and glycosaminglycans, along with elastic fibres. This layer is the major component of the free edge. The glycosaminglycans and proteoglycans are hydrophilic and attract water molecules.¹¹ This characteristic causes the ground substance to expand and swell at the free edge, providing a natural physical protective buffer to the leaflet along the point of apposition to offset the effect of leaflet closure at the free edge. Beneath the spongiosa is the fibrosa layer. It is the major load-bearing layer, comprising the central structural collagenous core of the leaflet. The collagen fibres are compact and aligned providing strength and stiffness to the leaflet and are surrounded by glycosaminoglycans and proteoglycans. The fibrosa layer is situated nearest to the ventricular surface of the leaflet that faces the greatest pressure during valve closure. This layer extends from the annulus into two-thirds of the leaflet; it is absent at the free edge. The final layer of the mitral leaflet is the ventricularis, which is covered by a continuous sheet of endothelial cells that overlie elastic fibres and collagen fibres. The thickness of each layer varies from the attachment site at the annulus to the free edge. At the proximal region of the leaflet, near the annulus, the fibrosa is the thickest layer but it becomes thinner towards the free edge of the leaflet and is totally absent at the edge. The spongiosa and atrialis layers increase in thickness distally becoming the main component of the leaflet at the free edge.

Myocardial cells from the atrium do extend a short distance into the base of the mitral leaflet supporting the leaflet. However, there is no myocardial continuity between the atrial and ventricular walls in the normal leaflet. At the atrioventricular junction, fibrofatty tissues interpose around the circumference. A complete cord-like fibrous ring as implied by the term ‘annulus’ seldom exists.¹² At this fibrous–myocardial junction where the leaflet inserts, there are a number of smooth muscle cells associated with veins and arterioles. These vessels are confined to the base of the leaflet.

The abnormal mitral valve

Complete closure (coaptation) and correct apposition (symmetrical overlap, usually a minimum of 4–5mm) of both leaflets is essential in preventing regurgitation. Since there are a number of ways in which valve failure may occur, it is useful to first establish the underlying aetiology, as this aids in initating the process of understanding the mechanisms involved in valve failure. However, the two are not necessarily synonymous; it is nonetheless a useful starting point. Carpentier’s functional classification describes leaflet motion in relation to the mitral annular plane. Type 1 describes normal leaflet motion. Mitral regurgitation is due to either perforation of the leaflet, such as trauma or endocarditits, or annular dilatation, usually the result of left ventricular disease. Type 2 describes excessive leaflet motion above the annular plane into the left atrium and is a result of leaflet prolapse usually the result of degenerative disease. Finally type 3 describes leaflet restriction and is categorized into two types; type 3a, where the restriction is throughout the cardiac cycle, i.e. in systole and diastole (usually the result of rheumatic valve disease) and type 3b, where the leaflet restriction is seen in systole alone (usually the result of regional wall motion abnormalities sen in ischaemic mitral regurgitation). The commonest mitral regurgitation aetiologies are degenerative (∼60%), rheumatic (post-inflammatory, 12%) and functional (25%). The latter includes ‘ischaemic’ mitral regurgitation. Other less common causes include congential abnormalities and endocarditis. With all these aetiologies mitral annular (or orifice), dilatation is observed to varying degrees.

Degenerative mitral valve diease

The term ‘degenerative’ covers a range of abnormalities and includes Marfan’s and Ehler’s Danlos syndrome. Changes to the valve include thickening and stretching (due to disruption of the structural collagen core) of the leaflet tissue¹³ (Figure 5). The abnormal leaflets can become twice as extensible.^14,15 A spectrum from a single segment of one leaflet through to all segments of both leaflets may be involved. The former has been coined ‘fibroelastic deficiency’ by Carpentier, whereas the latter describes Barlow’s disease with myxomatous-type leaflets (Figure 6). In fibroelastic deficiency, often the prolapsing segment is relatively normal in appearance; the prolpase being the result of focal chordal elongation with or without rupture. At the other end of the spectrum, the widespread involvement of the majority of the segments is seen. This process affects the subvalvular structures with chordal thinning and elongation. This results in the effected leaflet segments ballooning into the left atrium.^16–18 Echocardiographically, they are described as ‘prolapsing’ back into the atrium. The mural leaflet is the most frequent area to develop thickening.^19,20 Mechanical stresses on the degenerative chords have the propensity to rupture.^21,22 If this involves the primary chords (to the leaflet rough zone), then there maybe total eversion of the leaflet free edge into the left atrium. This is described as a ‘flail’ segment and its recognition is helpful as it is inevitably associated with severe regurgitation. The same disease process can result in focal regions of thickening with retraction and restriction, although this is far less common.

Figure 5

(A) Normal adult mitral valve at 22 years old. The clear zone of the aortic leaflet (arrow) is thin only at the freee edge does the normal leaflet become thickened. (B) Floppy mitral valve demonstrating the thickening of the leaflets along with the elongation of the tendinous chords (32 years old). (C) Histological section of a normal mitral valve. With increasing age, more elastic fibres are present (purple staining fibres) alongside collagen fibres (blue). F, fibrosa; A&S, atrialis and spongiosa. Massons trichrome stain, ×2.5 (37 years old). (D) This histological section of a floppy mitral valve shows the near absence of fibres in the central fibrosa of the leaflet (bracket). Non-disrupted collagen fibres are present within the attached chords (arrows). Elastic van Geison stain, ×2.5 (27 years old).

Figure 5

Figure 6

Three-dimensional transesophageal images, surgical view (live 3D zoom mode). Image 1 (fibroelastic deficiency) shows a single segment prolapse, A1 which is flail due to chordal rupture. The remainder of the anterior (aortic) and posterior (mural) leaflets are relatively normal in appearance. Image 2 shows Barlow’s valve, with multiple segment involvement (prolapsing segments are labelled). Deep clefts or indentations can also be appreciated. LAA, left atrial appendage; AV, aortic valve.

Figure 6

Primary defects of the leaflet have been observed in our practice. These include unusually deep clefts within the valve, which may be within a segment and extend from the free edge to the annulus (Figure 7). This is usually the primary site of regurgitation. This can occur without obvious prolaspe of the segment, although it is usually seen adjacent to the prolpase. This type of relevant anatomy is increasingly being observed with the routine use of three-dimensional echocardiography, with its ability to image the MV in real time in the beating heart. It has been postulated that such defects could represent congenital lesions and are the underlying abnormality that cause such valves to regurgitate. Further PM abnormalities have also been noted in some patients and may represent the same congenital process (see earlier).

Figure 7

Three-dimensional transesophageal images, surgical view (live 3D zoom mode). The white arrow points to a deep cleft within the P2 segment, which extens from the free edge to the annulus. This coincided with the region of severe mitral regurgitation.

Figure 7

The regurgitant jet may cause mechanical attrition resulting in the secondary feature of fibroelastic thickening. Fibrin and platelet-rich thrombi aggregates are seen at the leaflet free edge and contribute to leaflet thickening.^23,24 These aggregates can be attributed to abnormal jet flows of blood and asymmetrical regurgitation of flow between the leaflets.²⁵

Rheumatic mitral regurgitation

Rheumatic valve disease is an acquired abnormality and usually involves some degree of valve stenosis with or without mitral regurgitation. Typically, the leaflets become fused at the commissures (Figure 8). The leaflets thicken and become rigid, whereas the chords can be shortened and attach to fibrotic PMs. These changes represent post-inflammatory changes which usually progress over time. Additionally, calcification within the leaflets, annulus, and subvalvular apparatus may occur. Fusion of the leaflets results in an eccentrically located funnel-shaped orifice. The mechanism of regurgitation is leaflet restriction with reduced motion described both in systole and in diastole. This is distinguished from functional mitral regurgitation where the primary abnormality is the left ventricle, and unless severe, the restriction of leaflet motion is seen in systole alone.

Figure 8

(A) Specimen demonstrating rheumatic mitral valve. The leaflets fuse from the zones of leaflet apposition (arrows). LAA, left atrial appendage. (B) Three-dimensional transesophageal images, surgical view (live 3D zoom mode). The leaflets are thickened and the commissures are fused. LAA, left atrial appendage. (C) showing a rheumatic mitral valve. Congenital stenosis of the valve is due to the fusion of the papillary muscles. Ao, aorta.

Figure 8

Functional mitral regurgitation

In this form of mitral regurgitation, the MV leaflets and subvalvular apparatus are morphologically normal. There is instead an abnormality of the left ventricular wall (with or without cavity dilatation) with a resultant change in left ventricular geometry. The wall motion dysfunction can be focal or global; the location and extent of which are reflected in the degree of PM malposition. This places tension on the chordal apparatus and is reflected in the restriction of leaflet motion in systole. An inferoposterior myocardial infarction with a thinned akinetic inferoposterior basal ventricular wall typically causes posterior leaflet restriction in the region of P3 and P2. There may be complete failure of coaptation in this region (leaflet tips fail to meet) or apposition (leaflets coapt but there is loss of the usual rough zone overlap of 4–5 mm, which is reduced) (Figure 9).

Figure 9

Three-dimensional transesophageal images, surgical view (live 3D zoom mode). This shows ischaemic mitral regurgitation. The patient suffered an inferoposterior infarction with resultant tethering of the posteromedial papillary muscle. The image depicts the failure of coaptation (dotted region) of leaflets in the P2 and P3 regions. These segments are resticted to closure in systole.

Figure 9

Conclusion

The complex interactions of the normal MV are reliant on each component playing a complete role for the efficient working of the valve. Mitral regurgitation can be primary due to leaflet abnormalities, such as degenerative or rheumatic, and secondary due to dysfunction of the left ventricule with an otherwise structurally normal MV (such as dilated or ischaemic cardiomyopathy). An understanding of the normal anatomy of the MV complex and how this changes in disease states are important when assessing the mechanism of valve failure. This in turn will aid the assessment of the likelihood of a successful surgical MV repair and its potential durability.

Acknowledgements

Specimen images: Prof Yen Ho, Cardiac Morphology Unit, Royal Brompton Hospital.

Conflict of interest: none declared.

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Mitral Valve Replacement: Open | Johns Hopkins Medicine

What is an open mitral valve replacement?

An open mitral valve replacement is a surgery to replace a poorly working mitral valve with an artificial valve. The mitral valve is 1 of the heart’s 4 valves. It helps blood flow through the heart and out to the body. The mitral valve lies between the left atrium and the left ventricle. Your doctor will replace your poorly working mitral valve with an artificial valve. This will ensure that blood can flow into the left ventricle and then flow out to the body normally, without putting extra stress on the heart. The surgery is called “open” because it uses a traditional larger incision to expose the heart. This incision is larger than the incision used in minimally invasive mitral valve replacement surgery.

Why might I need an open mitral valve replacement?

The procedure may be necessary if the mitral valve is working poorly. Surgical repair of the mitral valve is often possible, but sometimes the valve needs to be replaced.

Mitral valve stenosis and mitral valve regurgitation (also known as mitral insufficiency) are two different types of problems that might need valve replacement.

In mitral valve stenosis, the valve is unable to open fully, and less blood is able to move from the left atria into the left ventricle.
In mitral valve regurgitation, the valve is leaky. Some blood leaks back into the left atrium instead of moving forward into the left ventricle.

These valve problems can lead to such symptoms as fatigue and shortness of breath. If these symptoms become severe, surgery may be necessary.

Both mitral stenosis and mitral regurgitation can result from general aging of the valve. Other causes of mitral valve disease include:

Ischemic heart disease (coronary artery disease)
Infection of the heart valves
Heart failure
Rheumatic fever

What are the risks of an open mitral valve replacement?

Most people who have an open mitral valve replacement have a successful outcome, but there are certain risks. Your particular risks will vary based on your overall health, your age, and other factors. Be sure to talk with your doctor about any concerns that you have. Possible risks include:

Infection
Bleeding
Irregular heart rhythms
Blood clots leading to stroke or heart attack
Complications from anesthesia
Continued leaking of the valve
Damage to nearby organs
Memory loss or problems with concentration

Certain factors increase the risk of complications, like:

Chronic illness
Other heart conditions
Lung problems
Increased age
Being obese
Being a smoker
Infections

How do I get ready for an open mitral valve replacement?

As you plan for the surgery, you and your doctor will decide what kind of valve will work best for you. Your surgeon will replace your valve with a biological valve or a mechanical valve.

Biological valves are made mainly from pig, cow, or human heart tissue. Biological valves don’t last as long as mechanical valves
Mechanical valves are man-made. If you receive a mechanical valve, you will need to take blood-thinning medicine for the rest of your life. Mechanical valves also have an increased risk of infection.

Talk with your doctor about how to prepare for your upcoming surgery. Remember the following:

Avoid eating or drinking anything after midnight before your surgery.
Try to stop smoking before your operation. Ask your doctor for ways to help.
You may need to stop taking certain medicines before your surgery. Follow your doctor’s instructions if you usually take blood-thinning medicines like warfarin or aspirin.

You may need to arrive at the hospital the afternoon before your operation. This is a good time to ask any questions you have about the procedure. You may need some routine tests before the procedure to assess your health before surgery. These may include:

Chest X-ray
Electrocardiogram (ECG)
Blood tests
Echocardiogram
Coronary angiogram (to assess blood flow in your heart arteries)

About an hour before the operation, someone will give you medicines to help you relax. In most cases your surgery will proceed as planned, but sometimes another emergency might delay your operation.

What happens during an open mitral valve replacement?

Check with your doctor about the details of your procedure. In general, during your open mitral valve replacement:

A doctor will give you anesthesia before the surgery starts. This will cause you to sleep deeply and you will not feel pain during the operation. Afterwards you won’t remember it.
The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
Your doctor will make an incision down the middle of your chest. To access your heart, your doctor will separate your breastbone.
The surgery team will attach you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
Your surgeon will remove your current mitral heart valve and replace it with a new valve.
The surgery team will remove the heart-lung machine.
The team will wire your breastbone back together.
The team will then sew or staple the incision in your skin back together.

What happens after an open mitral valve replacement?

After your open mitral valve replacement:

You will begin your recovery in the intensive care unit or a recovery room.
When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
Most people who have mitral valve replacement notice immediate symptom relief after their surgery.
The team will carefully monitor your vital signs, such as your heart rate. They may hook you up to several machines so the nurses can check these more easily.
You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. Someone will usually remove the tube within 24 hours.
You may have a chest tube to drain excess fluid from your chest.
Bandages will cover your incision. These can usually come off within a couple of days.
You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you can ask for pain medicine.
In a day or two, you should be able to sit in a chair and walk with help.
You may perform breathing therapy to help remove fluids that collect in your lungs during surgery.
You will probably be able to drink the day after surgery. You can have regular foods as soon as you can tolerate them.
You may receive elastic stockings to help blood circulate through your leg veins.
You will probably need to stay in the hospital for around 5 days.

After you leave the hospital:

Make sure you have someone to drive you home from the hospital. You will also need some help at home for a while.
You will probably have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
You may tire easily after the surgery, but you will gradually start to recover your strength. It may take several weeks to fully recover from your surgery.
After you go home, take your temperature and your weight every day. Tell your doctor if your temperature is over 100.4°F (38˚C), or if your weight changes.
Ask your doctor when it is safe for you to drive.
Avoid lifting anything heavy for several weeks. Ask your doctor about what is safe for you to lift.
Follow all the instructions your healthcare provider gives you for medications, exercise, diet, and wound care.
Make sure all your dentists and doctors know about your medical history. You may need to take antibiotics before certain medical and dental procedures to prevent getting an infection on your replacement valve.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure

Mitral Valve Regurgitation | Michigan Medicine

Topic Overview

What is mitral valve regurgitation?

Mitral valve regurgitation means that one of the valves in your heart—the mitral valve—is letting blood leak backward into the upper area of the heart.

Heart valves work like one-way gates, helping blood flow in one direction between heart chambers or in and out of the heart. The mitral valve is on the left side of your heart. It lets blood flow from the upper to the lower heart chamber.

See a picture of mitral valve regurgitation.

When the mitral valve is damaged—for example, by an infection—it may no longer close tightly. This lets blood leak backward, or regurgitate, into the upper chamber. Your heart has to work harder to pump this extra blood.

Small leaks are usually not a problem. But more severe cases weaken the heart over time and can lead to heart failure.

What causes mitral valve regurgitation?

There are two forms of mitral valve regurgitation: chronic and acute.

Chronic mitral valve regurgitation, the most common type, develops slowly.
- Primary regurgitation means there is a problem with the anatomy of the valve. The valve does not work well and does not close tightly. This might happen because of problems like calcium buildup on the valve. It can also happen in people who have mitral valve prolapse.
- Secondary regurgitation means another heart problem causes the valve to not close tightly. The anatomy of the valve is typically normal. The heart problem, such as heart failure, affects the heart muscle, and this causes regurgitation.
Acute mitral valve regurgitation develops quickly and can be life-threatening. It happens when the valve or nearby tissue ruptures suddenly. Instead of a slow leak, blood builds up quickly in the left side of the heart. Your heart doesn’t have time to adjust to this sudden buildup of blood the way it does with the slow buildup of blood in chronic regurgitation. Common causes of acute regurgitation are heart attack and a heart infection called endocarditis.

What are the symptoms?

Symptoms of mitral valve regurgitation include being tired or short of breath when you are active.

If your heart weakens because of your mitral valve, you may start to have symptoms of heart failure. Call your doctor if you start to have symptoms or if your symptoms change. Symptoms include:

Shortness of breath with activity, which later develops into shortness of breath at rest and at night.
Extreme tiredness and weakness.
A buildup of fluid in the legs and feet, called edema.

Acute mitral valve regurgitation is an emergency. Symptoms come on rapidly. Symptoms include severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain.

How is mitral valve regurgitation diagnosed?

Because you may not have symptoms, a specific type of heart murmur may be the first sign your doctor notices. Further tests will be needed to check your heart. Tests may include:

Echocardiograms, which use ultrasound to see how serious the valve problem is.
An electrocardiogram (EKG, ECG) to look for abnormal heart rhythms.
A chest X-ray to check heart size.
Cardiac catheterization to see how serious the problem is.

Finding out that something is wrong with your heart is scary. You may feel depressed and worried. This is a common reaction. Sometimes it helps to talk to others who have similar problems. Ask your doctor about support groups in your area.

How is it treated?

Treatment for chronic cases includes regular tests to check how well the valve and the heart are working. You may take medicines to treat complications. You may take medicine to treat a heart problem that is causing the regurgitation.

You may need to have the mitral valve repaired or replaced. Your doctor will check many things to see if surgery is right for you. These things include the cause of the regurgitation, the anatomy of the valve, if you have symptoms, and how well your heart is pumping blood.

If you have chronic mitral valve regurgitation, your doctor may want you to make some lifestyle changes to help keep your heart healthy. He or she may advise you to:

Quit smoking and stay away from secondhand smoke.
Follow a heart-healthy diet and limit sodium.
Be active. Ask your doctor what level and type of exercise is safe for you. You may need to avoid intense activity.
Stay at a healthy weight, or lose weight if you need to.

Treatment for acute mitral valve regurgitation occurs while you are in the hospital or the emergency room. You need surgery right away to repair or replace the valve.

Cause

There are two forms of mitral valve regurgitation (MR): chronic and acute. Chronic mitral valve regurgitation develops slowly over several years. Acute MR develops suddenly.

Chronic mitral valve regurgitation

There are two types of chronic mitral valve regurgitation: primary and secondary.

Primary means there is a problem with the anatomy of the valve. The valve does not work well and does not close tightly.

Primary regurgitation can be caused by:

Calcium buildup as a person ages. The mitral valve may become hard, or calcified, around the tough ring of tissue (annulus) to which the mitral valve flaps are attached. Normally the mitral annulus is soft and flexible. But as a person ages, calcium may build up inside the annulus. This hardened mitral valve cannot close completely, and blood leaks backward (regurgitates) into the upper left chamber of the heart (atrium).
Mitral valve prolapse.
Heart defects or abnormalities present at birth (congenital heart defects).
Endocarditis, which is an infection of the lining of the heart and heart valves. This infection can scar the mitral valve.
Autoimmune diseases that can damage the mitral valve, such as rheumatoid arthritis or lupus.
Marfan’s syndrome, which is a connective tissue disease.
Rheumatic fever, which can scar the heart valves. This can prevent them from closing completely.
Previous use of the weight-loss medicine fen-phen (phentermine and fenfluramine/dexfenfluramine), which appears to increase the risk of heart valve disease.
Injury to the heart or the chordae tendineae, which are strong, flexible cords that control the opening and closing of the mitral valve.

Secondary means another heart problem is causing the valve to not close tightly. The anatomy of the valve is typically normal. The heart problem affects the heart muscle, and this causes regurgitation.

Secondary regurgitation can be caused by heart problems that affect the left ventricle. These problems include:

Acute mitral valve regurgitation

Acute mitral valve regurgitation occurs when the mitral valve or one of its supporting structures ruptures suddenly, creating an immediate overload of blood volume and pressure in the left side of the heart. Your heart doesn’t have time to adjust to the increased volume and pressure of blood (as it does in chronic MR).

Causes of sudden rupture include:

Injury to the chordae tendineae. Endocarditis may also cause the chordae tendineae to rupture.
Injury to the chest.
Heart attack, which may cause the rupture of the muscle (papillary) surrounding the valve.
Problems with a prosthetic mitral valve.
Perforation of the mitral valve flap (leaflet), caused by endocarditis.

Symptoms

Symptoms of chronic mitral valve regurgitation (MR) may take decades to appear. With acute MR, symptoms come on suddenly, and you are critically ill.

Call your doctor right away if you have new or different symptoms. These include:

Shortness of breath with exertion, which may later develop into shortness of breath at rest and at night.
Fatigue and weakness.
Fluid buildup in the legs and feet.
Heart palpitations, if atrial fibrillation develops.

Chronic mitral valve regurgitation

Primary MR. If you have mild-to-moderate primary MR, you may not have symptoms. If you have severe disease, you may have symptoms when you are active. Symptoms include:

Fatigue and weakness.
Shortness of breath.

Secondary MR. If you have secondary MR, you likely have symptoms of the heart problem that has led to the regurgitation. You may have symptoms of heart failure or coronary artery disease.

Acute mitral valve regurgitation

Acute mitral valve regurgitation is an emergency. Symptoms of acute mitral valve regurgitation appear suddenly. Symptoms include severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain.

What Increases Your Risk

Risk factors for mitral valve regurgitation (MR) include:

Age. Wear and tear of the mitral valve occurs over time. This increases the likelihood of blood leaking back into the atrium.
Having mitral valve prolapse.
Having had rheumatic fever, because it can cause scarring on the valve. This can result in incomplete closure.
Having heart failure or coronary artery disease. These problems can change the shape of the left ventricle and cause the valve to not close normally.

When to Call a Doctor

Call
911
or other emergency services immediately if you or a person you are with has:

Symptoms of a heart attack, including chest pain or pressure.
Symptoms of stroke.
Loss of consciousness (syncope).
Symptoms of acute mitral valve regurgitation including severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain.

Call a doctor immediately if you have:

Symptoms of heart failure, such as shortness of breath, fatigue, and swelling in the legs and feet.
Mitral valve regurgitation (MR) and are having symptoms of infection such as fever with no other obvious cause. Be alert for signs of infection if you have recently have had any dental, diagnostic, or surgical procedure.
Irregular heartbeats.
Fainting episodes.
Palpitations.
Shortness of breath.
A decreased ability to exercise at your usual level.
Excessive fatigue (without other explanation).

If you are coughing up blood, call a doctor immediately.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you do not have symptoms of MR, your doctor will still want to see you for regular checkups. Your doctor will want to see you as soon as you have symptoms for the first time. If your doctor has talked with you about what to do if you have symptoms, follow your doctor’s instructions. Contact your doctor if your symptoms get worse.

Who to see

Health professionals who can evaluate symptoms that may be related to mitral valve regurgitation include:

They frequently can also order the tests needed for further evaluation of symptoms.

Exams and Tests

Chronic mitral valve regurgitation (MR) can be difficult to diagnose. It is a “quiet” condition and often has no symptoms, or your symptoms may be confused with other heart-related conditions.

Chronic MR is often diagnosed during a routine checkup or a visit to the doctor for another condition. A heart murmur may be the first sign leading your doctor to the diagnosis, especially if you have no other symptoms.

Acute MR causes sudden symptoms and is much less common than chronic mitral valve regurgitation.

When your doctor suspects you have MR, he or she will discuss your medical history, do a physical exam, and likely order tests to check your heart. Your doctor uses the information to find out how severe your MR is. For more information, see Mitral Valve Regurgitation: Severity.

Medical history and physical exam

To find out the severity of your MR, your doctor will ask you to describe the symptoms you are experiencing, such as shortness of breath, fatigue, or chest pain.

During the physical exam, the doctor will take your blood pressure, check your pulse, listen to your heart and lungs, look at the veins in your neck (jugular veins), and check your legs and feet for fluid buildup (edema).

Echocardiogram

Echocardiogram (sometimes called an echo or echocardiography) is a type of ultrasound exam. It helps your doctor find out how severe your MR is. Also, echocardiography can help determine whether the heart’s main pumping chamber (left ventricle) is functioning properly, whether any structural problems exist that may affect the mitral valve, and whether the chambers of the heart are enlarged.

Electrocardiogram

An electrocardiogram (EKG, ECG) is a test that measures the electrical signals that control the rhythm of your heartbeat.

Although the EKG may reveal abnormal electrical activity in the heart, further testing is often still needed to find out the severity of MR and to confirm whether MR is causing enlargement of the left ventricle. The result of an EKG is often normal in people who have mild MR.

Imaging tests

A chest X-ray may be done to evaluate heart size and to assess symptoms of MR, such as shortness of breath. Calcium deposits on the heart valves may sometimes be seen on a chest X-ray.

A magnetic resonance imaging (MRI) test may be done to see how well the heart is pumping blood and to check how severe the MR is.

Cardiac catheterization

Cardiac catheterization may be done to confirm the severity of mitral valve leakage seen on an echocardiogram.

Regular checkups

How often you see your doctor and what tests are done will be determined by how severe your chronic mitral valve regurgitation is.

**Recommended frequency for checking mitral valve regurgitation**
^{footnote 1}
Severity of mitral regurgitation	How often you should have an echocardiogram
Mild	Every 3 to 5 years
Moderate	Every 1 to 2 years
Severe	At least every 6 to 12 months

Treatment Overview

Treatment for chronic mitral valve regurgitation (MR) includes monitoring your heart function and symptoms. It may include treating symptoms as they develop. If another heart problem has caused the regurgitation, you will get treatment for that heart problem. If MR becomes severe, the mitral valve may need to be repaired or replaced.

Treatment for acute MR is immediate. Medicines and urgent surgery are usually needed.

Chronic regurgitation

Treatment depends on whether you have primary MR or secondary MR. It also depends on if you have symptoms or complications and how severe the regurgitation is.

Monitoring. If you don’t have symptoms and you only have mild-to-moderate regurgitation, your doctor may only monitor your heart and valve function with an echocardiogram. You will see your doctor regularly. How often you get this test depends on the severity of regurgitation. For more information, see Exams and Tests.

Medicine. Your doctor may prescribe medicines to treat complications or treat the heart problem that caused the mitral regurgitation. For more information, see Medications.

Valve replacement or repair. Surgery may be done to replace the mitral valve. Surgery or a procedure may be done to repair the mitral valve. For more information, see Surgery.

Acute regurgitation

Initial treatment for acute MR includes medicines as needed to stabilize your condition. If medicines don’t help, an intra-aortic balloon pump may be used for a short time to help circulate blood and ease the workload on your heart. Surgery may be done immediately to replace or repair the valve.

Ongoing Concerns

Chronic primary mitral valve regurgitation (MR) develops slowly. And most people go years without having any symptoms. Before symptoms start, your condition may not be serious and you generally feel good. But even during this time, MR is doing irreversible damage to your heart. Because of this ongoing damage, your doctor may suggest a valve repair or replacement before you start having symptoms. Although it may be difficult to think about a surgery or procedure when you feel well, not having the valve repaired or replaced could lead to heart failure.

You will begin to have symptoms of chronic MR when your heart begins to weaken. A variety of medicines are available to treat your symptoms as MR progresses and to prevent complications.

Complications

People with mitral valve regurgitation sometimes develop serious complications including:

Living With Mitral Valve Regurgitation

Make healthy lifestyle changes

If you smoke, try to quit. Medicines and counseling can help you quit for good. Avoid secondhand smoke too.
Your doctor will also recommend that you follow a heart-healthy diet and limit how much sodium you eat.
Be active, but ask your doctor what level of exercise is safe for you. You may need to be cautious about physical activity if you have symptoms, irregular heart rhythms, or changes in your heart size or function. But regular activity, even low-level activity such as walking, will help keep your heart healthy. If you want to start being more active, talk to your doctor first. Your doctor will help you create a safe exercise plan. For more information, see Mitral Valve Regurgitation and Exercise.
If you need to lose weight, try to reach and stay at a healthy weight. For help, see the topic Weight Management.

Take care of yourself

See your doctor right away if you have new symptoms or symptoms that get worse. For more information, see When to Call a Doctor.
See your doctor regularly. And get the tests you need, such as echocardiograms, to assess your heart. For more information, see Exams and Tests.
Manage other health problems including high blood pressure, diabetes, and high cholesterol.
Practice good dental hygiene and have regular checkups. Good dental health is especially important, because bacteria can spread from infected teeth and gums to the heart valves.
Get a flu vaccine every year. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor if you need another dose.
Talk with your doctor if you have concerns about sex and your heart. Your doctor can help you know if or when it’s okay for you to have sex.

Medications

Medicines do not prevent or correct the damage to the heart caused by mitral valve regurgitation (MR). For chronic regurgitation, they might be used to treat complications of mitral regurgitation. They might be used to help treat the heart problem that has caused secondary MR. In acute regurgitation, medicine is used as emergency treatment before surgery.

Chronic regurgitation

In chronic MR, you may take medicine if you have symptoms and a low ejection fraction. You may take medicine to treat heart failure.

Medicine after surgery

Antibiotics. If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis. You will likely take antibiotics after surgery to repair or replace a valve. If you have had rheumatic fever, you may take antibiotics to avoid getting it again.

Blood thinners. Blood thinners prevent blood clots after surgery. Blood thinners include antiplatelet medicine, such as aspirin, or anticoagulant medicine. If you have an artificial heart valve, you may need to take this medicine for the rest of your life.

Acute regurgitation

In acute MR, medicines are used in the hospital to stabilize your condition until you can have surgery to replace or repair the valve.

Complications

Medicines are used to prevent or treat complications of mitral regurgitation such as atrial fibrillation or heart failure. For more information, see the topics:

Surgery

With chronic mitral valve regurgitation (MR), a mitral valve repair or replacement might be recommended. Surgery may be done to replace the mitral valve. Surgery or a procedure may be done to repair the mitral valve. Whether surgery is right for you depends on many things including the cause of MR.

With acute MR, urgent surgery to repair or replace the valve is usually needed. In some cases, surgery to correct the cause of acute MR may also be needed.

Chronic regurgitation

Primary MR. Valve repair or replacement is the only cure for primary MR, because the abnormal shape of the mitral valve is causing the regurgitation.

Your doctor will check many things to see if surgery is right for you. Your doctor may check to see if:

Your valve can be repaired.
You have symptoms.
You have severe regurgitation.
Your heart has pumping problems (low ejection fraction).
Your left ventricle is larger than normal.

Repair is typically preferred over replacement. The decision between repairing or replacing the valve depends on the type of damage you have. For more information, see the topic Mitral Valve Regurgitation: Repair or Replace the Valve.

Secondary MR. Valve repair or replacement cannot cure secondary MR, because another heart problem is causing the mitral valve to not close properly. Treatment of the heart problem, such as heart failure, may be the right treatment for you. Some people might benefit from a repair or replacement of the mitral valve.

Your doctor will check many things to see if surgery is right for you. Your doctor may check to see if:

You have severe symptoms of heart failure.
You have severe regurgitation.
You are having heart surgery for another problem.

Surgical repair

To repair the valve, the surgeon may:

Reshape the valve by removing excess valve tissue.
Add support to the valve ring by adding tissue or a collar-shaped structure around the base of the valve.
Attach the valve to nearby cordlike heart tissues (chordal transposition).

Surgical replacement

With replacement, the badly damaged valve is removed and a mechanical (plastic or metal) or bioprosthetic valve (usually made from pig tissue) is sewn into place. Before you have valve replacement surgery, you and your doctor will decide on which type of valve is right for you.

For more information, see:

Transcatheter repair

A transcatheter procedure is a newer way to repair a mitral valve. It does not require open-heart surgery. It is a minimally invasive procedure. A doctor uses catheters in blood vessels to insert a device in the valve. The device helps keep blood from leaking backward. This may relieve symptoms and improve quality of life. This procedure is not available in all hospitals. And it is not right for everyone. It might be done for a person who can’t have surgery or for a person who has a high risk of serious problems from surgery.

References

Citations
Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
Other Works Consulted
Adams DH, et al. (2011). Mitral valve regurgitation. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 2, pp. 1721–1737. New York: McGraw-Hill.
Badiwala MV, et al. (2009). Surgical management of ischemic mitral valve regurgitation. Circulation, 120(12): 1287–1293.
Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
Oakley RE, et al. (2008). Choice of prosthetic heart valve in today’s practice. Circulation, 117(2): 253–256.
Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
Rodriguez L, Gillinov AM (2007). Mitral valve disease. In EJ Topol, ed., Textbook of Cardiovascular Medicine. Philadelphia: Lippincott Williams and Wilkins.
Stout KK, Verrier ED (2009). Acute valvular regurgitation. Circulation, 119(25): 3232–3241.
Whitlock RP, et al. (2012). Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e576S–e600S.

Credits

Current as of:
August 31, 2020

Author: Healthwise Staff
Medical Review:
Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology
Martin J. Gabica MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Michael P. Pignone MD, MPH, FACP – Internal Medicine

Minimally Invasive Mitral Valve Repair

The advent of minimally invasive mitral valve repair techniques and their application through a minimally invasive approach mark two major milestones in the history and evolution of mitral valve repair and surgery.

These techniques are now routinely applied to the majority of patients affected by mitral valve disease with excellent functional and cosmetic results.

Both malfunctions can often be present in the same mitral valve. The following diagrams show you how the heart and its valves create forward flow of oxygenated blood in our circulation and what happens if the mitral valve is malfunctioning.

The left side of the heart works with two one way valves. The first two pictures show you the normal valve mechanisms.

In the first picture the heart relaxes and fills up with oxygenated blood, the mitral valve is open to allow blood in the left ventricle and the aortic valve is closed.

In the second picture the heart contracts and the aortic valve opens to let the blood out into the aorta (the main pipeline). The mitral valve is closed to prevent the blood from leaking back into the left atrium.

Does it sound that complicated? That’s what your trusted plumber would call “a system with two check valves.”

The third picture shows what happens with Mitral Valve Stenosis. The most common cause of mitral valve stenosis is rheumatic heart disease.

Following a bout of rheumatic fever the mitral valve can be affected by chronic inflammation. The valve leaflets are “stuck” together because of gradual scarring that makes the valve opening too narrow to allow enough blood flow into the left ventricle. This flow impediment causes a pressure back up in the lungs. This “plumbing problem” explains what happens to patients with advanced mitral stenosis– their energy levels are very low (not enough blood flows through the body) and even a small amount of physical exercise will congest their lungs (because of the back up!) and give them severe shortness of breath.

As you can imagine, these patients’ lifestyles are very limited. The stuck valve leaflets can be separated surgically (commissurotomy). In third world countries where this pathology is very common and the financial means are much more limited than in the U.S., the heart surgeons still use an old but inexpensive technique.

It consists on inserting a finger through the valve to pry it open without stopping the heart. Most American and European surgeons use an open heart technique that allows a precise valve repair or replacement under direct vision. In selected cases the valve opening can be enlarged by inserting a thin balloon-tipped catheter similar to the ones used for angioplasties.

The balloon is then inflated across the valve to force it open. The choice of operative technique and type of repair or replacement is dictated by many factors. It is important to point out that each patient is in a unique situation that requires a tailored solution to his or her case.

The fourth picture shows Mitral Valve Regurgitation. When the mitral valve does not close properly at each heartbeat, a part of the oxygenated blood in the left ventricle “leaks” back into the left atrium and the lungs instead of flowing forward. A severe degree of leakage makes the heart pumping action very inefficient and causes lung congestion. The most common symptoms associated with this condition are shortness of breath, generalized weakness, inability to endure even light physical exercise and, at times, chest discomfort and pain.

Mitral Valve Prolapse (MVP)

One of the most common deformities we encounter in patients with a leaky valve is the Mitral Valve Prolapse. MVP is a very common condition and it tends to run in families. Recent statistical studies report a 5% incidence in the general population and up to 17% among young women (one out of six).

Let’s see what it is: the mitral valve normally functions as a one-way valve and is made out of two leaflets of fibroelastic tissue that open and close like window shutters to direct the blood flow inside the heart.

When one or both leaflets dilate and loosen up excessively, the valve does not function properly. The leaflets will acquire an abnormal amount of up and down motion which may cause the valve to “leak” because of an incomplete closure.

Six patients out of ten affected by this condition have absolutely no symptoms. Physical and emotional stress (i.e.: a bad flu, a pregnancy, relocation or changes in the work environment) can at times be the cause of the first symptoms.

The most common symptoms are palpitations, a fast heart rate, chest pain, panic attacks or sudden anxiety, extreme lack of energy, or headaches. A mitral valve prolapse can be often discovered by your physician with a simple physical exam and by listening to your heart with a stethoscope.

When the heart contracts and pushes blood against these abnormally dilated valve leaflets a characteristic sound can be heard. Why? Well….think of the sound of a large sail distended by a sudden gush of wind. That sound is generated by the abnormal motion of the valve leaflets! An echocardiogram can confirm the diagnosis and show us the valve motion and degree of its leakage, if any.

A regular follow up program with repeat echocardiograms is strongly recommended to identify those patients who develop a severe leakage. In a small percentage of cases the mitral valve is so distorted and malfunctioning that a surgical correction becomes necessary to prevent a progressive and irreversible damage to the heart muscle.

Minimally Invasive Mitral Valve Repair & Surgery

Many patients with severe symptomatic mitral insufficiency and their doctors make the mistake to postpone talking to a surgeon until their symptoms have become unbearable. Let me make it absolutely clear:

With severe mitral valve regurgitation the heart tires out and can be irreversibly damaged unless a mitral valve repair is promptly performed before intense symptoms are present.

Other elements that influence the early timing of corrective surgery are the enlargement of the heart in repeat echocardiograms and the onset of atrial fibrillation. An early mitral valve repair in a heart surgery center with solid experience in repair techniques is currently the best choice.

When the valve is repaired patients can enjoy the clinical benefit of a more natural solution (keeping their own functioning mitral valve) while avoiding the disadvantages of a replacement with artificial valves.

The repair technique consists of fine tailoring of the defective valve followed by the insertion of a ring around it to prevent subsequent changes in valve size and shape. The following diagrams will give you a more detailed rendition of the most common repair techniques we use in our patients.

Our minimally invasive mitral valve repair and heart surgery techniques allow us to repair or replace these defective valves reliably and through a small chest wall incision, with less pain and bleeding, a quick recovery and excellent cosmetic results. In most women the surgical incision can be actually hidden underneath the breast.

Oftentimes a floppy mitral valve can be repaired rather than replaced, avoiding altogether the need for blood thinners and decreasing the chance of embolic events (i.e.: strokes) more commonly seen if a valve replacement with a mechanical valve is performed instead of a repair.

Patients with significant mitral regurgitation (leaky valve) should be aggressively evaluated and followed up to decide if and when they need a surgical correction that could dramatically improve their quality of life and longevity.

The following is a surgical video to illustrate some of the techniques applied in minimally invasive mitral valve repair.

Schwarzenegger spoke about the state of health after replacing the aortic valve

Hollywood actor Arnold Schwarzenegger left the clinic after another heart operation. The former governor of California had his aortic valve replaced to avoid serious cardiac complications.

Actor, bodybuilder and former Governor of California Arnold Schwarzenegger told his followers on social networks about the good health after replacing the aortic valve in the heart. He decided to undergo another operation to prevent serious cardiac problems that could lead to complications in the movement of blood from the left ventricle of the heart to the aorta.

“Thanks to the team at the Cleveland Clinic, I now have a new aortic valve in addition to the pulmonary valve from my previous surgery. I feel fantastic and have already walked around Cleveland, seeing the wonderful statues in the city, ”wrote the 73-year-old artist. In addition to a photograph from a hospital ward, Schwarzenegger published pictures from a walk around the city, where he went after recovering from surgery.

The artist survived the previous surgical intervention in March 2018, when he had a pulmonary valve installed back in 1997 replaced. The actor admitted that in the process of manipulation complications arose that almost cost him his life. The fact that the doctors pulled the star of “Terminator” from the other world, he said only a year after the operation.

“Most of all I was worried not because I might die, but because I would disrupt the shooting of The Terminator. I really didn’t want to let the team down.That is why I insisted on returning home soon, ”the actor said in an interview with The Mirror.

Schwarzenegger recently starred in the sixth film in the Terminator: Dark Fate franchise, which was released last year and grossed $ 261 million worldwide. Despite the warnings of doctors because of heart problems, “Iron Arnie” did not stop working out in the gym. He admitted that he cannot imagine his life without serious physical exertion.

“It has always been important for me to play sports.I believe that competent loads cannot harm anyone, ”the actor is convinced.

Last summer, Schwarzenegger, in the company of Hollywood actors Sylvester Stallone and Dolph Lungren, filmed a video in which they said they were not going to grow old. They explained their decision by saying that “growing old is so ugly.” During the recording, Stallone joked that his hand looks better than Schwarzenegger’s face. However, the former governor disowned this statement, noting that he was beautiful.

“Look how handsome I am,” emphasized Schwarzenegger.

In the spring and summer, the winner of a number of bodybuilding awards showed fans examples of training during self-isolation. Schwarzenegger’s mansion is located in a large area, which he drove in a truck in one of the videos and gave a speech.

“No one should go out, especially those who are 72 years old. After 65, you should not leave the house during an epidemic, stay at home and eat there, not in restaurants, advised Schwarzenegger. “We cannot control the virus, but we can control our fitness.”

After that, the former governor of California began to train with a barbell. According to him, exercises can be done without the help of special equipment, observing the consistency of training.

During self-isolation, he lived in his country house in Los Angeles with Lulu’s donkey, Whiskey pony and Cherry the dog. The actor regularly shared videos and photos in the company of pets on social networks.

OPEN PROSTHETICS (AORTIC / MITRAL) VALVE – CARDIOVASCULAR SURGERY

The heart is a pump that circulates blood throughout the body.It is a self-excited muscle that has its own conduction and the ability to rhythmic contractions occurring simultaneously. The heart has a regulatory center and 4 chambers, separated by valves and septa (muscle walls). Valves regulate the direction of blood flow during heartbeats, and septa isolate blood flow in the right and left chambers of the heart. This positive and negative pressure gradient in different areas of the heart is responsible for creating contractions that pump blood throughout the body.

Heart valve surgery is performed open or closed (with or without opening the chest) to replace or repair heart valves that are not working properly. The aortic and mitral valves are the most commonly replaced valves. The aortic valve separates the left ventricle of the heart (the main pumping chamber) and the aorta (the largest artery that carries blood to the extremities and internal organs). The mitral valve separates the left ventricle of the heart and the left atrium.

What types of valve disorders are there?

Valve problems make the heart work too hard. There may be changes in the structure of the valves, leading to disruption of their operation. The cause may be birth defects, aging, or some medical condition. Some patients are born with valvular heart disease, while others develop valve disease later over time. Valvular heart disease that occurs before birth is called congenital heart disease.Such valves may have insufficient leaflet tissue, be of the wrong size or shape, or there may be a deficiency in a valve opening that, when functioning normally, allows blood to flow correctly.

There are 3 main types of heart defects:

Regurgitation (the valve does not close completely, and blood goes where it should not normally flow (comes back))
Stenosis (the heart valves do not open completely, this does not allow ensure sufficient blood flow from the heart)
Atresia (in cases where the heart valve does not have a hole for blood flow)

What is valve replacement surgery?

Most valve replacements are performed on an open heart.This means that the surgeon opens the patient’s chest. A new artificial valve is placed in place of the affected valve. In some cases, valve replacement can be done without opening the chest, requiring only a series of small incisions. The choice of the type of surgery will depend on the complexity of the patient’s case (which valve needs to be replaced, the clinical picture of the disease and the risk of surgery).

The operation is performed under general anesthesia and takes 3 to 5 hours.During the operation, most of the time, the patient’s heart will not work and the patient will be connected to a heart-lung machine. As an alternative to this, there are several surgeries that can be performed on a beating heart.

Diseases of the aortic valve

Diseases of the aortic valve are pathological conditions characterized by dysfunction of the bicuspid valve. These pathologies are congenital and acquired.Such diseases include:

Aortic valve stenosis is a pathological condition in which there is a narrowing of the valve lumen.
Regurgitation is a disease that develops with aortic valve insufficiency. In this situation, the valve flaps do not close enough, which is why blood flows back into the left ventricle from the aorta.

According to medical observations, 80% of cases of aortic valve diseases are associated with rheumatic diseases.So, rheumatic endocarditis often becomes the cause of the development of an inflammatory process in the valve. Systemic lupus erythematosus, septic endocarditis and syphilis also lead to diseases of the aortic valve.

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Symptoms

Diseases of the aortic valve may not be felt for a long time. So, a patient for 10-15 years may not even suspect about the presence of any heart problems.This is because insufficient valve functionality is compensated for by the work of the left ventricle. However, after the ventricle ceases to cope with the loads assigned to it, the patient develops symptoms of the disease, such as:

heart palpitations; 90 049
shortness of breath;
dizziness;
painful in the heart;
pallor of the skin;
Rapid pulsation of the carotid arteries (“dance of carotids”).

For diseases of the aortic valve, the so-called “de Musset symptom” is characteristic, which is characterized by twitching of the head in time with the heartbeat.There is also a “Muller’s symptom” – the pulsation of the sky. If the disease is not treated, then over time it progresses, which is accompanied by an increase in the above symptoms. In addition, with the progression of the disease, the patient develops edema and congestion in the lungs.

Stages of the disease

When it comes to mitral stenosis, the stage of the disease is determined based on the valve diameter:

Absence of stenosis

valve area from 2 to 5 square centimeters.

Light stenosis

valve opening area more than 1.5 quadrant centimeters.

Moderate stenosis

area from 1 to 1.5 quadrant centimeters.

Severe stenosis

valve opening less than 1 square centimeter.

Diagnosis of diseases of the aortic valve

The following types of examinations are used to diagnose diseases of the aortic valve in Israel:

Electrocardiography, which diagnoses an increase in the size of the left ventricle.
Chest X-ray is a test method that detects left ventricular enlargement and the focus of calcification in the aortic valve.
Echocardiography (Echo-KG) – allows you to see the aortic valve in detail.
Doppler echocardiography. This is a special type of echocardiography that allows the doctor to determine the severity of the stenosis.

In the case when the above diagnostic techniques do not provide comprehensive information about the disease, the patient is referred for cardiac catheterization.This procedure boils down to the fact that a catheter is inserted through an artery in the groin or thigh to the patient, which reaches the heart through the vessels. A contrast medium is injected through the catheter to fill the coronary arteries. Under the influence of X-rays, the contrast agent becomes visible, which allows the doctor to detect blockage of the coronary arteries, combined with stenosis of the aortic valve.

Depending on the results obtained, your doctor may recommend that you start treatment, or be limited to medical supervision for a while.

Treatment

At the First Medical Center in Tel Aviv, medical and surgical techniques are used in the treatment of diseases of the aortic valve.

With the help of drug therapy, it is possible to normalize the heart rhythm and improve the functional functioning of the heart. The patient is also prescribed drugs that normalize blood pressure and lower blood cholesterol levels. Such measures help to slow the progression of aortic valve stenosis, but it will not be possible to eliminate the stenosis with drugs alone.For this, Israeli clinics resort to surgical intervention.

Surgical treatment

Valve replacement. During surgery, the affected valve is removed and replaced with an artificial (mechanical) or biological valve. Artificial valves are made of durable materials with long lasting durability. The disadvantage of a mechanical valve is that it promotes the formation of blood clots, so the patient will have to take anticoagulants for prophylactic purposes throughout his life.

As for biological prostheses, they are made from pig, cow or human tissue. The disadvantage of such valves is the fact that they need to be replaced relatively often (compared to metal ones). So, biological aortic valves last 10 years or more, and if their functionality decreases, then a decision is made to replace them. Which prosthetics technology to use in each case is decided by the team of doctors, based on the results of the examination and the patient’s health.After aortic valve replacement surgery, the patient needs to be observed by a doctor for another 1.5-2 months.

Surgery is an effective treatment for aortic valve stenosis. However, after performing any heart surgery, there is always a risk of developing arrhythmias, which are caused by the presence of stenosis. In order to minimize the likelihood of developing any postoperative complications, the patient should strictly follow all the doctor’s instructions, in particular, take the prescribed medications.

Innovative methods of treating diseases of the aortic valve in Israel

Among the innovative methods of treating diseases of the aortic valve, the First Medical Center in Tel Aviv will use minimally invasive plasty of the valve. To carry out plastic surgery on the valve, it is necessary that the patient does not have rough scars, and his state of health would allow performing surgery on the heart.

For the prevention of infectious diseases after aortic valve replacement surgery, it is necessary to undergo antibiotic treatment.

Cost of treatment

Cost of treatment	$
Dr. Tupilsky, cardiologist – consultation	550

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How to find an Israeli specialist for treatment

Coordinators of the First Medical Center in Tel Aviv will help you find a qualified specialist in Israel, who will provide you with all the necessary assistance.You can preliminarily familiarize yourself with the biographies of Israeli doctors on our website. These are the best specialists in Israel, who have had more than a dozen years behind them.

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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat

Feasibility and reproducibility
The proposed MR model is highly reproducible, with a well-defined opening in the mitral leaflet achieved in 100% of the rats used in this study. Figure 6 A shows the direction of the needle when it is inserted into the mitral valve. Figure 6 B depicts a hole in a mitral valve leaflet from a representative rat, planted 2 weeks after the procedure.

Survival and Adverse Events
Sixteen rats were MR-induced using the methods described. Severe MR was generated in all rats. One rat died within an hour of MRI from acute respiratory failure.Thus, the overall survival at 2 weeks after MR creation was 93.75%. Mortality or major cardiac side effects such as bleeding, arrhythmias, or stroke were not observed in any animal during the two weeks of follow-up.

Severity of Mitral Regurgitation
Table 1 summarizes the hemodynamic profile of the left heart at baseline and 2 weeks after MR induction. Paired t-test was used to determine the statistical significance between baseline and severity Mr at week 2, with statistical significance defined as p qlt; 0.05. Mr jet was bright for two weeks after surgery, with an average area of 21.15 and 8.11 mm ² (p / 0.0001 compared to baseline) and an average integral time velocity of 39.72 and 7.52 see Normalized MR fraction at 2 weeks was 41.91 and 8.3%, which is considered serious according to the guidelines of the American Echo Society. The severity of MR was adequate to induce a reversal of the pulmonary flow, with a decrease in the S / D ratio from 0.91 to 0.17 at baseline to -0.69 and 0.65 at 2 weeks (p qlt; 0.0001).

Reconstruction of the cardiac chamber
Figure 7 shows morphological changes in a representative heart after severe MR at 2 weeks, compared to a heart from a rat that underwent sham surgery. After two weeks after surgery, the heart from the MR rat was spherical and highly dilated, with a 29.65% increase at the end of diastolic volume (baseline EDV: 462.49 and 39.62 L; and after 2 weeks MR EDV: 599.79 th 58.590 l, p / t; 0.0001). End systolic volume increased by 10.06%, from 153.90 and 18.78 L at baseline, to 169.36 and 24.64 L (p 0.01) within 2 weeks after MR induction.Cardiac hypercontraction was observed in the first two weeks, as expected, due to a decrease in load, as seen from the increased ejection fraction (66.77 and 2.02% at baseline to 71.82 and 2.31% at 2 weeks (pq lt; 0.0001)). Exposure to Mr for two weeks increased the left atrial area by 99.59% (rn; 0.0001).

Figure 1: Intubation technique. ( A ) 16 G angiocat with a guide wire used for endotracheal intubation in this rat model; ( B ) Image of pharyngeal vision with an otoscope and target area for endotracheal tube insertion; ( C ) Final configuration of the endotracheal tube; ( D ) Attach the endotracheal tube to a mechanical ventilator.Please click here to view a larger version of this figure.

Figure 2: Transthoracic and transesophageal imaging. Transthoracic Imaging: ( A1 ) Setting for transthoracic imaging of the rat, depicting the angle of the probe image; (A2 ) Parasternal long axis of vision of the heart; (A3 ) Short view of the heart axis. Transesophageal imaging: ( B1 ) 8 Fr intracardiac echo probe with a probe inserted into the esophagus during animal intubation; ( B2 ) High views of the left heart esophagus, depicting the left atrium, mitral valve and left ventricle.Please click here to view a larger version of this figure.

Figure 3: Surgical procedure. () Surgical layout showing left thoracotomy at ^{to the 5th} intercostal space, and an ICE catheter into the rat esophagus for imaging guidance, and a 23 G needle is inserted into the apex of the LV where the same purse string suture is located. ( B ) Surgical view during transesophageal echo-driven leaflet perforation. ( C ) Echocardiographic image of insertion of a needle into the left ventricle in diastole.( D ) Echocardiographic image of needle insertion into the left ventricle in systole. ( E ) Echocardiographic image of a needle pierced through the anterior leaflet. Please click here to view a larger version of this figure.

Figure 4: Image of the procedure. ( A ) Basic echo 2 chamber view before MR creation; ( B ) 23 G needle, visualized on echo during beating of the heart, advanced into the left atrium through the anterior mitral valve leaflet; ( C ) Color Doppler images showing the MR jet seen in systole.Please click here to view a larger version of this figure.

Figure 5: Representative echo image to check the severity of MR at 2 weeks after surgery. ( A ) The left atrial region is traced in white and the MR of the reactive region is traced in red; ( B ) MR VTI trace in red; ( C) Pulmonary flow showing systolic reversal. Please click here to view a larger version of this figure.

Figure 6: needle puncture. ( A ) Ex vivo orientation of the needle puncture to the heart. The needle is punctured through the apex of the LV at an angle, the longitudinal section of the LV with the needle pointed towards the mitral leaflet, and the needle is punctured through the mitral leaflet into the atrial space. ( B ) Representative explant photograph showing a hole in the anterior mitral leaflet. Please click here to view a larger version of this figure.

Figure 7: Gross morphology of whole hearts of a sham control rat (A) and a rat that underwent POS operation (B) 2 weeks after surgery. The severe IR rat has significant left ventricular dilatation and chamber enlargement compared to sham guided controls. Please click here to view a larger version of this figure.

	Basic unise (n No 15)	2wk MR (n # 15)	p-value
Left atrial area (mm ²)	25.03 and 8.70	49.95 and 14.78	r Zlt; 0.0001
MR jet area (mm ²)	0	21.15 and 8.11	r Zlt; 0.0001
Mr fraction (%)	0	41.91 and 8.30	r Zlt; 0.0001
MR VTI (cm)	0	39.72 x 7.52	r Zlt; 0.0001
S wave (m / s)	0.39 and 0.07	-0.51 and 0.41	r Zlt; 0.0001
D wave (m / s)	0.44 and 0.04	0.70 and 0.17	r Zlt; 0.0001
S / D wave ratio	0.91 and 0.17	-0.69 and 0.65	r Zlt; 0.0001

Table 1: Characteristics of mitral regurgitation.

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MitraClip technique in the treatment of mitral valve insufficiency

Currently, due to the difficulties associated with the organization of treatment in Turkey, Switzerland, South Korea and India, we have suspended the processing of applications in these areas.

If you are interested in organizing treatment in Germany, please leave a request and our specialists will contact you as soon as possible.

Surgical reconstruction or mitral valve replacement is the second most common cardiac valve surgery. In European countries with developed medicine, operations on the mitral valve are increasingly performed endoscopically, using a minimally invasive technique. For example, 61 out of 80 specialized cardiac surgery clinics in Germany actively use this technique, performing 45% of all isolated mitral valve surgeries using it.

The risks of surgery with the MitraClip are much lower than those of surgery with classic open reconstruction or valve replacement. It is successfully used in elderly patients and patients with severe concomitant pathology. Nevertheless, the technique has a number of limitations, therefore it can be recommended for a limited number of cardiac patients. Another important condition for successful treatment is a decent technical equipment of the clinic and the surgeon’s experience in carrying out such interventions.

For whom mitral valve reconstruction is indicated
Minimally invasive technique
Advantages and limitations of minimally invasive mitral valve surgery
Leading clinics specializing in minimally invasive interventions

For whom mitral valve reconstruction is indicated 9000 valve, or mitral regurgitation, is a congenital or acquired heart defect in which the valve leaflets cannot close completely.Due to this, with each contraction of the left ventricle, some of the blood flows back into the left atrium, and not into the aorta, as it normally does. Excess blood in the left atrium gradually obstructs blood flow to the lungs, leading in severe cases to respiratory failure and pulmonary edema.

Most often, the mitral valve is affected in the following situations:

Formation of congenital heart disease (for example, splitting of the mitral valve leaflet). With a small size of the defect, such defects are detected already in adulthood.
Rheumatic heart disease, infection with group A streptococci.
Infective endocarditis (bacterial, viral).
Systemic connective tissue diseases (systemic lupus erythematosus, systemic scleroderma).
Ischemic heart disease (papillary muscle dysfunction or postinfarction left ventricular aneurysm).
Dilated or hypertrophic cardiomyopathy, myocarditis.
Genetic syndromes (eg Marfan syndrome).

The need for surgical treatment is determined by the clinical condition of the patient and the degree of influence of the defect on hemodynamics. For example, if the patient has no complaints of shortness of breath, and he tolerates physical activity well, then the cardiologist is limited to observation in dynamics and supportive therapy.

When dyspnea occurs with minimal physical activity, edema of the lower extremities, heart palpitations, cough in the supine position and weakness, mitral valve insufficiency is considered clinically significant.If conservative drug therapy does not give a lasting improvement in the condition, then the cardiologist recommends considering an operative correction of the defect.

Technique for minimally invasive surgery

The essence of minimally invasive surgery using the MitraClip system is to firmly connect the weakened or deformed mitral valve leaflets using a special clamp made of chromium and cobalt alloy. In contrast to the classic surgery, in which the valve leaflets are manually sutured using suture material, the MitraClip is placed on the affected leaflets endoscopically without opening the chest.

At the first stage of the operation, anesthesia is performed and a probe is placed for real-time transesophageal echocardiography (EchoCG). Echocardiographic guidance allows the surgeon to monitor the advancement of the MitraClip catheter through the blood vessels and the placement of the system on the mitral leaflets.
A guide catheter is then inserted through a small incision into the patient’s femoral vein, at the end of which the MitraClip is located.
Moving through the blood vessels under ultrasound guidance (EchoCG), the catheter reaches the left atrium. Here, the flaps of the MitraClip are opened and placed on the affected side of the mitral valve.
After fixing the leaflets of the MitraClip, a control echocardiography is performed – the surgeon evaluates the blood flow through the reconstructed mitral valve. EchoNavigator software can also be used for monitoring, which combines information obtained during echocardiography and radiography.Based on the follow-up examination, the surgeon may place an additional MitraClip on the valve cusps.
The guide catheter is removed from the femoral vein. A purse string suture is applied to the incision, which is removed within 8 hours after the completion of the procedure. The total duration of the operation is 1-1.5 hours.

Due to the good tolerability of the procedure, the patient can go home within 1-3 days after the procedure. Further recommendations include outpatient monitoring by a cardiologist and taking antiplatelet drugs – Plavix for 1 month and Aspirin for 6 months.

Advantages and limitations of minimally invasive mitral valve surgery

Minimally invasive correction of mitral regurgitation using the MitraClip combines the advantages of effective surgical treatment and endoscopic surgical access:

Low operational risks: no need to perform sternotomy, the chest remains intact; low risk of bleeding and no need for donor blood transfusion; no need to connect the patient to a heart-lung machine.
Low trauma and minimal pain – the operation is performed through a small incision in the groin.
Excellent cosmetic result – the sutures are removed from the incision the next day after the intervention.
Short hospital stay – the patient is discharged 1-3 days after the intervention. Symptoms of mitral insufficiency disappear completely or significantly decrease already during these periods.
Low risk of recurrence – in 90% of operated patients, the mitral valve retains its function for 10 years or more.The safety and efficacy of the technique has been confirmed by the results of the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) study.

However, the use of the MitraClip has some limitations:

The technique is used only if the initial mitral valve area is> 4 cm ². Otherwise, there is a risk of developing postoperative mitral stenosis.
The technique demonstrates lower efficiency compared to the classic operation.Efficacy was compared by the degree of mitral regurgitation reduction (abnormal blood flow through a damaged mitral valve).
Objective data on the effectiveness and safety of the MitraClip are limited by the results of the EVEREST II study. Such information is insufficient for a comprehensive assessment of the long-term effectiveness and risks of the methodology.

Therefore, the use of the MitraClip system is mainly indicated for elderly patients with high operational risks.The technique is much easier to tolerate compared to classical open surgery, but at the same time, it does not replace a complete reconstruction of the mitral valve.

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Leading clinics specializing in minimally invasive interventions

For minimally invasive cardiac interventions, a clinic must have appropriate endoscopic equipment and equipment for high-quality imaging during surgery (echocardiograph, high-resolution CT and MRI ).Another prerequisite is the surgeon’s specialization in operations of this type and a sufficient number of operations per year (at least 250).

These clinics include:

University Hospital Oldenburg, Oldenburg, Germany
University Hospital Medipol Mega Istanbul, Istanbul, Turkey
University Hospital Ulm, Ulm, Germany
University Hospital Tübingen, Tübingen, Germany
University Hospital Erlangen, Erlangen, Germany

Booking Health organizes the treatment of foreign patients in the world’s leading clinics.Booking Health is a certified medical tourism operator who provides assistance at all stages of treatment, from choosing a clinic to long-term follow-up after returning to your home country.

Booking Health specialists will help you with such important moments:

Choosing the right clinic based on the annual qualification profile
Direct communication directly with the attending physician
Preparing a treatment program without repeating previous diagnostic examinations
Ensuring a favorable cost of clinic services , without surcharges and coefficients for foreign patients (saving up to 50%)
Make an appointment on the desired date
Monitoring the medical program at all stages
Assistance in purchasing and shipping medicines
Communication with the clinic after the completion of treatment
Account control and return of unspent funds
Organization of additional examinations
Service of the highest level: booking hotels, plane tickets, transfers
Translation services and translation of medical documents

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Leave a request with medical and contact information on the official website of Booking Health, and a medical consultant will contact you during the day.Booking Health will help you get treatment in the shortest possible time and significantly improve the quality of your life.

Choose treatment abroad and you will undoubtedly get an excellent result!

Authors: Dr. Valeria Kruzhilina, Alexandra Solovey

Read:

Why Booking Health – Questions and Answers

How not to be mistaken in choosing a clinic and a specialist

7 reasons to trust the rating of clinics on the Booking Health website

Booking Health – Quality standards

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90,000 Mitral valve prolapse diagnostics

Work in the insurance medicine clinic led to communication with a large number of young, healthy patients from the point of view of a cardiologist, every second of whom proudly claims that he had mitral valve prolapse on echocardiography.

These statistics made me “take up the pen” and state my view on the question.

The article was written for specialists, but anyone who wants to understand the issue, the patient will understand that there is nothing complicated in these pictures.

Let’s open the best, in my opinion, the Russian guide to echocardiography of Rybakova Marina Konstantinovna 2008, page 131: “Currently in our country there is an overdiagnosis of mitral valve prolapse in children and adolescents.”

It is clear, I was far from the first to notice “overdiagnosis” (unreasonable overdiagnosis) in young people.

Here is a typical picture of a four-chamber section, according to which most echocardiographers in Russia unambiguously put MK prolapse:

If you outline the left heart, the usual actions of a Russian echocardiographer would be as follows:

A straight line is drawn from the base to the edge of the anterior cusp of the mitral valve (SCV), then the center sag is measured in millimeters and a conclusion is made confidently about the presence of prolapse of the anterior cusp of the mitral valve and its degree.

That is, according to the majority of echocardiographers in Russia, for the diagnosis of prolapse it is necessary and sufficient that in one (apical) position the valve looks like the chin of Peter Griffin from the famous animated series:

Attempts to find a clear definition of MK prolapse on the Russian and English-speaking Internet do not give anything outstanding.

Google Translate gives 2 meanings of the word “prolapse” – dropout, omission.

The image search leads to a result unexpected for the cardiologist.It turns out that prolapses also occur in other organs, in particular, in the rectum.

Here are the most innocent pictures for “rectal prolapse”. This is the circuit:

And this is life:

From this I conclude that prolapse is a clearly pathological significant displacement of an organ beyond its normal anatomical location.

M.K. Rybakova in her book on the same 131 page writes: “It is necessary to distinguish between TRUE leaf prolapse and their billowing.

Prolapse, or sagging, of one or both cusps of the mitral valve in systole is considered true ONLY if it is registered in TWO echocardiographic positions: apical four-chamber AND PARASTERNAL along the long axis of the left ventricle. “End of quotation.

This is where the dog is buried, dear fellow echocardiographers. In the parasternal position, 99% of the so-called “prolapses” are immediately cut off.

How often have you seen this picture in the parasternal position? Me not.

Further on the same page of the echocardiography manual Rybakov writes:

“It is necessary to distinguish between physiological prolapse of the mitral valve – without impairing its function, and pathological prolapse of the mitral valve – with pathological mitral regurgitation.”

That is, wait a minute, first of all, even a TRUE prolapse may not be a pathology, but a NORMAL.

And secondly, to diagnose PATHOLOGICAL mitral valve prolapse, you need to have leaflet prolapse in TWO projections and PATHOLOGICAL regurgitation on the MC (that is, moderate or significant degree).

I believe that compliance with these rules will reduce the setting of pathological prolapses once again by 10.

Now I turn to the pictures of the public English-speaking Internet.

Currently, most authors consider the sagging of the valves to be NORMAL (hello to Peter Griffin, only the chin is inverted due to the fact that in the apical position on the screen of the ultrasound machine, the heart is located apex up, and here – apex down):

Let’s google the original language pictures for “mitral valve prolapse”.

Several images contain both norm and prolapse. Click to enlarge this picture. The designations of the normal valve and prolapse are underlined in red, the blood flows into systole are shown with yellow arrows:

It turns out that prolapse in the understanding of modern English-speaking authors of the Internet is NOT the sagging of the CENTER of the valve, but its EDGE, which leads to an increase in the reverse discharge of blood into the left atrium – regurgitation, or, God forgive me for the literal translation – “regurgitation” (hereinafter this Russian translation I will not use).

A few more illustrations that are clearly interpreted.

On the left is another upside-down hello from Peter Griffin in the norm image:

This shows the mitral valve cycle (open – closed) – again the problem is in the edge of the leaflet:

We go further along the gallery:

A is a description of replacing a prolapsed valve with an artificial valve:

We try to draw conclusions from this publicly available information:

1.Prolapse in the understanding of modern English-speaking Internet authors is the sagging of the EDGE of the valve leaflet, leading to significant regurgitation (reverse blood flow) during systole (contraction) of the ventricle.

2. The sagging of the CENTERS of the valves has a very distant relation to prolapse.

Dear colleagues! Please grant the proud title of MC Pathological Prolapse carrier only to those who truly deserve it.

90,000 New technologies for aortic valve implantation save the most hopeless patients

“Stenosis can be eliminated by undiscovered method”

Our newspaper has already written about hybrid heart surgeries, and more than once.But this was the time when they were not yet on stream, but were performed with extreme caution and only in large federal cardiac centers, and by the most experienced surgeons. In particular, the legendary cardiac surgeon, Academician of the Russian Academy of Sciences Renat AKCHURIN, spoke about the miracle novelty in MK. Today, Renat Suleimanovich has performed almost 150 severe cardiovascular surgeries performed by this method. In his opinion, “hybrid cardiovascular surgery allows achieving the maximum therapeutic effect in a minimally traumatic way, since it combines the advantages of open and endovascular approaches.Moreover, all this takes place inside the working heart, which is very important, especially for elderly patients, for whom open surgery is contraindicated. ”

In total, more than 3.5 thousand of such operations have already been carried out in Russia. Only in one “National Medical Research Center of Cardiology” since 2009 – about a thousand! Without exaggeration, this center today is the leading medical institution in our country, on the basis of which cardiology and cardiovascular surgery are developing. It is not surprising that it was at this site that leading cardiologists from all over the world gathered to discuss the problems of innovative hybrid technologies.What are their advantages and are there any problems?

– Cardiovascular diseases all over the world are still one of the leading causes of mortality, – commented one of the conference organizers, Doctor of Medical Sciences, Head of the Laboratory of Hybrid Methods of Treatment of Cardiovascular Diseases of the Department of Cardiovascular Surgery of the Federal State Budgetary Institution ” National Medical Research Center of Cardiology “named after A.L. Myasnikova Timur IMAEV. – The trend in the development of modern cardiovascular medicine is the ever-increasing role of minimally invasive (bloodless) treatment methods.Obviously: at the turn of the 20th and 21st centuries, the next stage in the development of cardiovascular surgery, called “hybrid surgery”, began. It is an integration of several specialties: cardiovascular surgery, interventional cardiology, radiology, anesthesiology, intensive care and a number of others.

It must be said that in recent years the importance of hybrid and endovascular methods of treatment of diseases of the cardiac surgical profile has grown significantly. The number of transcatheter interventions performed for structural diseases of the valvular apparatus of the heart is increasing annually.Since the first such aortic valve implantation, performed in 2002 by the French professor Cribier, more than 750,000 such interventions have been performed worldwide, which has led to a paradigm shift in the treatment of aortic stenosis in elderly patients at high surgical risk.

And in our country, transcatheter aortic valve implantation has already become a clinical reality, and today it is performed not only in the capital, but also in many federal cardiac surgery centers. But the most important thing is that even in the most severe patients, mortality has decreased during such operations.Today it is about 3%, and even less in clinics where these operations are on stream, it does not exceed 1.5%, the expert says.

And in the near future, the already accumulated evidence base allows us to count on the expansion of indications for the use of this method of surgical correction of aortic defects in the population of already younger patients of lower risk groups.

Equally important, the success in the field of transcatheter aortic valve surgery has stimulated the development of minimally invasive interventions on other heart valves.By 2020, the world has accumulated experience of 100 thousand operations of transcatheter mitral valve repair, the results of several large studies have been published, which laid the foundation for the introduction of the technology into real practice.

Another direction of this method is endoprosthetics of the aorta and large arteries. Already, more than 700 such operations are performed in Russia per year. The minimally invasive treatment of aortic aneurysms of various localization has become possible, which makes it possible to prevent fatal complications of this formidable disease.

Timur Imaev.

The risk of sudden death can be canceled

“It is also very important that today dozens of specialized cardiovascular centers have already been created and are operating in the regions of Russia,” added Aleksey KOMLEV, cardiologist of the Department of Cardiovascular Surgery at the National Medical Research Center of Cardiology. – Now the number of high-tech operations performed using hybrid surgical techniques is growing throughout the country.And the introduction of precisely low-traumatic methods makes it possible to prolong the life of middle-aged Russians who, until recently, had to refuse radical surgical care due to the extremely high risk of surgery with artificial circulation.

By the way, the scientific component of the last conference was focused on the most relevant methods of treating diseases of the heart valves and aorta. This was discussed, in particular, by specialists from leading research centers not only in Moscow, St. Petersburg, but also in Novosibirsk, Rostov-on-Don, Tomsk, Krasnoyarsk, Ufa and other cities of our country.Cardiac surgeons from Belarus, Uzbekistan, Lithuania, leading experts from Italy, Israel, Germany, Great Britain, Sweden, Hungary, China also shared their vision of the problem.

Without exaggeration, such conferences have acquired the status of an international scientific and medical event. However, the main goal, according to Academician Akchurin, remains the fastest introduction of advanced diagnostic and treatment methods and high surgical technologies accumulated in the world into the practice of Russian healthcare.

But the Russians themselves would like to know about the causes of stenosis of the aortic valve of the heart, and about its first symptoms, and most importantly – what this disease threatens in the future. As the experts explained, there are many reasons for the onset of stenosis, as well as the manifestations of this pathology. Among the main ones are congenital changes (bicuspid aortic valve) and acquired (age-related calcification – calcification, rheumatism, etc.). Symptoms can also be different. At the initial stage, the disease is asymptomatic and practically does not limit the patient’s life in anything.But with severe stenosis, there are signs of heart failure, shortness of breath even with a minimum of movement, attacks of heart pain (angina pectoris), edema of the lower extremities, periodically sudden weakness, up to loss of consciousness (in this case, there is a high risk of sudden death).

By the way, until recently, the only “gold standard” for the treatment of severe stenosis of the aortic valve was open heart surgery – “aortic valve replacement”. To do this, it was necessary to make an incision in the middle of the chest in order to gain access to the heart during the operation, connect a heart-lung machine, stop the heart, and only then remove the non-functioning valve and replace it with a prosthesis.And this method gave good results, but was not shown to everyone. There was a high risk of both the operation itself and possible complications in elderly patients, especially in those who already had severe concomitant diseases. Therefore, they were often refused surgery and were prescribed only supportive drug therapy.

But, fortunately, a more gentle way of treating such patients has now been found. In 2007, transcatheter aortic valve implantation passed European certification and became widely used in the treatment of patients with severe stenosis.The advantages of such operations, as they say, are obvious. They are carried out literally through a 2 cm incision on the thigh, so the duration of the operation is shorter and recovery is much faster. Patients are preparing to be discharged in a week. And no long-term rehabilitation.

Such operations have been carried out in our country for over 10 years.

Aortic aneurysm is also at gunpoint

– The other day in our center, for the first time in Russia, a third-generation valve was installed in a patient.Unlike the previous ones, its location can be freely changed during the operation, inside the heart, – Timur Imaev shared the details of the process. – If we are not satisfied with something when the valve is implanted into the aortic position, then inside the patient we can change his landing zone. This improves both the result of the operation and eliminates the problems that were inherent in the valves of the previous generation. And all this happens inside a working heart. Using this method, it is now possible to treat not only stenosis of the aortic valve, but also aneurysm of the aorta, restore the heart rhythm, and change the pulmonary artery valve.

And one more significant plus: the valves of the new generation are designed for 10-12 years, and then another one can be placed inside the first one, for approximately the same period. Quite recently it seemed like a miracle, but today it is already a reality.

But progress does not stand still. Experts intend to improve this technology: large-scale research is being carried out to expand the use of this technique. And in the world cardiac guidelines, this technology is “recommended for wider use along with the classic open surgery.”

… So, the future in the treatment of cardiovascular diseases, as it is now clear, belongs to hybrid technologies. But we must admit: not everything depends on cardiologists and cardiac surgeons. How affordable are these high-tech operations in our country? After all, the need of patients for such operations is high due to the high prevalence of diseases of the aortic valve in Russia. However, quotas for high-tech medical care are not enough due to the high cost of the system for implantation of the aortic valve.Although it must be admitted: today more and more patients can get access to the innovative technique of aortic valve replacement. But not all of them. Many people have to stand on the waiting list for a long time.

Hope dies last …