The following concerns apply to both mitral valve stenosis
and mitral valve regurgitation. A concern specific to either condition will be
Failure to replace the valve before permanent damage occurs
Because a mitral valve problem can eventually cause
irreversible damage to your heart, it is important that you have your valve
repaired or replaced before it causes permanent damage. If you wait too long to
repair or replace your valve, the surgery may not substantially improve your
heart function. The following recommendations are from the American College of
Cardiology and the American Heart Association (ACC/AHA).1
For mitral valve stenosis, you should have
surgery to repair or replace your mitral valve if your valve area drops below
1.5 cm2 and you have serious, life-limiting
symptoms. If you delay surgery, your mitral valve may not be able to be
For mitral valve regurgitation, you may need valve
surgery before you have symptoms. You should have mitral valve surgery when
your ejection fraction drops below 60% and/or your left ventricle is dilated
more than 40 mm at rest. Although many people do not have any symptoms at this
early stage of the disease, having surgery on the valve before symptoms occur
can prevent irreversible heart damage.
Failure to treat multivalvular problems during surgery
It is important that you treat any valve problems you have with one
surgery. Treating one valve problem and leaving others will not alleviate all
of the stress placed on your heart from valve problems. This means the damage
that is being done to your heart will continue. This damage can have a serious
negative effect on your chances for survival immediately after surgery.
After years of being affected by multiple valvular disease, your heart
has adjusted to the combination of valve problems and has compensated for the
malfunctions to the best of its ability. When you fix one valve and not
another, the blood is still flowing incorrectly through your heart, and your
heart has not had time to compensate accordingly. This can create new heart
problems, which may be even harder to cope with than your original multiple
Valve surgery is a major procedure during which
you are placed under anesthesia, your chest is opened, and surgeons operate on
your exposed heart. This surgery places considerable stress on the body, and
you want to minimize the number of times you have open-heart procedures.
Correcting more than one valve problem in one operation may eliminate the need
for you to have additional open-heart surgeries.
Failure to treat other conditions simultaneously
Valve problems often occur in conjunction with other diseases of your
circulatory system, including
coronary artery disease (CAD). It is important that
your treatment be tailored to address both your valve problem and other
conditions you may have. Otherwise, you run an increased risk of developing
heart failure. In addition, as explained above,
open-heart surgery is an extensive procedure that places substantial strain on
the body. If you need surgery to correct mitral valve stenosis as well as CAD
(or other heart condition), it will be to your benefit to have these surgeries
done at the same time.
Ineffective/insufficient monitoring of the condition
After you have been diagnosed with a mitral valve problem, it is
important that your condition be monitored periodically for changes. This
monitoring should take place regularly and should utilize tests that allow your
doctor to accurately assess your condition.
For those with mitral valve stenosis, this test
must assess the valve area and the pressure gradient across your mitral
For those with mitral valve regurgitation, this test must
assess the ejection fraction.
If the test does not allow your doctor to assess these
valve functions, your doctor may not catch a worsening of the valve function.
Your heart has an amazing ability to compensate even when a valve is
Not monitoring regularly or not performing the
right tests can cause two problems. First, it may be difficult to measure
changes in your condition if you do not have a recent reading with which to
compare a new reading. Also, insufficient monitoring could allow your condition
to develop to a critical point before it is noticed and treated.
Failure to report symptoms
It is extremely important
that you report to your doctor all symptoms or changes in your symptoms. Your
doctor will rely on you to provide an accurate assessment of how you feel and
how your symptoms have changed since your last visit. Even if an issue seems
unimportant to you, you should mention it so that your doctor can assess it in
light of your condition and overall health. Without your help, your doctor may
miss important signs that signal important changes in your condition.
Bonow RO, et al. (2006) ACC/AHA 2006 guidelines 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 (Writing Committee to Revise the 1998 Guidelines for the
Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84-e231.
Robin Parks, MS
Kathleen M. Ariss, MS
Pat Truman, MATC
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
March 18, 2008
WebMD Medical Reference from Healthwise
March 18, 2008
This information is not intended to replace the advice of a doctor.
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