Atherosclerosis -- sometimes called hardening of the arteries -- can slowly narrow and harden the arteries throughout the body. When atherosclerosis affects the arteries of the heart, it’s called coronary artery disease.
Coronary artery disease is the No. 1 killer of Americans. Most of these deaths are from heart attacks, caused by sudden blood clots in the heart’s arteries.
Atherosclerosis can create life-threatening blockages, without you ever feeling a thing. Since we’re all at risk for coronary...
In general, surgery for
mitral valve prolapse (MVP) is only done if you have
mitral valve regurgitation. Valve repair or replacement are the two types of
surgery available to treat these conditions.
Both valve repair
and replacement are typically open-heart surgeries. Minimally invasive types of
surgery may be another option. This section describes open-heart
During valve surgery, you are given
general anesthesia. Surgery typically lasts about 3 to
5 hours. Your doctor makes a large incision in your chest. You are placed on a
heart-lung machine during the surgery. Blood is circulated outside of the body
and oxygen is added to it using a heart-lung (cardiopulmonary bypass) machine.
To protect the heart muscle from damage during surgery to replace the heart
valve, the heart may be cooled to slow or stop the heartbeat. The damaged
mitral valve is either repaired or removed and replaced with an artificial
(prosthetic) heart valve.
between repairing or replacing the valve depends on the type of damage to the
mitral valve. For instance, repair is more successful if there is limited
damage to certain areas of the mitral valve flaps (leaflets) or to the tough
fibers that control movement of the mitral valve leaflets (chordae tendineae).
But replacement is usually preferred for people who have a hard, calcified
mitral valve ring (annulus) or widespread damage to the valve and surrounding
To repair the heart valve, the
Reshape the valve by removing excess valve
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).
Heart valve replacement surgery
involves the removal of the badly damaged valve. The valve is replaced with a
plastic or metal mechanical valve, or a bioprosthetic valve, which is usually
made from pig tissue. The damaged valve is cut out, and the new valve is sewn
People who receive a mechanical heart valve are more
likely than those who receive a bioprosthetic heart valve to develop blood
clots in the heart. The clots may break loose, travel to the brain, and cause a
stroke. So if you have received a mechanical heart
valve to treat severe MR, you will need to take medicine for the rest of your
life to prevent clots from forming (anticoagulant medicine).
some cases, a plastic or metal valve may be preferred if you are already taking
anticoagulants for other reasons, such as
Before you have aortic valve replacement surgery, you and your doctor will decide on which type of valve is right for you. For help with this decision, see:
Recovery from heart valve surgery
usually involves a few days in an intensive care unit (ICU) of a hospital. Full
recovery from heart valve surgery can take several months. Recovery includes
healing of the surgical incision, gradually building physical endurance, and
After you have an artificial valve, your heart
function and your life will largely return to normal. You should feel better
than before you had the surgery if you had symptoms before surgery. For
example, you should no longer have shortness of breath and fatigue. But
if your heart was already severely affected before your surgery, you may
continue to have complications of heart disease.
be able to resume most of your normal activities, although you will have to
continue to monitor your condition. You need to watch out for symptoms of blood
clots and infections.
An artificial valve may need to be replaced
after a period of time. So be sure to see your doctor regularly.
Bioprosthetic valves last for about 8 to 15 years.
Why It Is Done
Surgery to repair or replace the
mitral valve is often required in MR. Surgery is generally done for mitral
valve prolapse (MVP) only when MR is present. The recommendations for surgery
for both conditions are generally the same.
Conditions that are most likely to require surgery
Sudden (acute) MR.
symptoms of heart failure.
MR with mild-to-moderate left
ventricular dysfunction (ejection fraction less than 60% and/or an enlarged
left ventricle more than 40 mm at rest).
Conditions that may require surgery
MR with an irregular heartbeat (atrial
fibrillation) but no symptoms and no signs of functional damage to the left
MR with elevated blood pressure in the lungs (pulmonary
hypertension) but no symptoms and no signs of functional damage to the left
MR with mild to severe left ventricular dysfunction, no
symptoms, and a high likelihood of preserving some of the related structures of
the mitral valve.
Conditions that are less likely to require surgery include:
Chronic MR with no symptoms and no signs of
functional damage to the left ventricle, even if surgical repair of the mitral
valve is likely to be successful.
MR with MVP and no signs of
functional damage to the left ventricle but with recurrent ventricle
arrhythmias despite treatment.
How Well It Works
If mitral valve repair is done before the heart is severely damaged by the faulty valve,
most people have excellent short- and long-term results.1
The outcome of mitral valve replacement depends on a person's overall health, including other health
The exact risks of mitral valve surgery vary
depending on the person's specific condition and general health prior to
surgery. In general, the risks include:
Effects from the operation itself (such as
bleeding, infection, and risks associated with anesthesia). These risks are
Blood clotting caused by the new valve. Replacement with a
mechanical valve requires lifelong treatment with medicine to prevent blood
Infection in the new valve. Infection is
more common with valve replacement than with valve repair.
of the new valve. Valve failure is more common with valve replacement than with
valve repair. Bioprosthetic valves last for about 8 to 15 years.
What To Think About
Repair versus replacement
Repair of the heart
valve usually is the preferred and more common type of surgery for MVP.
When the mitral valve is seriously damaged, heart valve replacement may
be recommended. Examples of serious damage or complicated conditions that might
lead to mitral valve replacement include:
Extensive ballooning of the mitral valve
(rather than a single flap that puffs up).
(calcification) of the valve.
Prolapse (bulging) of the valve at an
The decision regarding whether to repair or replace a
valve is based on many things, including the person's general health, the
condition of the damaged valve, the presence of other health conditions, and
the expected benefits of surgery. In some cases, the decision clearly may be in
favor of repair or in favor of replacement.
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.
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
George Philippides, MD - Cardiology
February 12, 2010
WebMD Medical Reference from Healthwise
February 12, 2010
This information is not intended to replace the advice of a doctor.
Healthwise disclaims any liability for the decisions you make based on this