If your chronicmitral valve regurgitation (MR) becomes severe or you
have symptoms of
heart failure, such as shortness of breath, swelling,
and fatigue, surgery to
repair or replace your mitral valve will be needed.
Regardless of symptoms, surgery is recommended when your
ejection fraction drops below 60% and/or your left
ventricle is larger than 40 mm at rest.1
Having surgery on your valve before symptoms occur may help you avoid heart
damage that is beyond repair. Some doctors believe it's best to repair or
replace the valve before you have severe symptoms, because people who have
severe symptoms don't recover as well as people who do not.
decision between repairing or replacing the valve depends on the type of damage
you have. For instance, repair is more successful if there is limited damage to
certain areas of the mitral valve flaps (leaflets) or to the chordae tendineae,
the tough fibers that control movement of the mitral valve leaflets. But
replacement is usually preferred for people who have a hard, calcified mitral
valve ring (annulus) or widespread damage to the valve and surrounding
Repair is typically preferred over replacement. Repair for mitral valve regurgitation:
- May lead to better long-term
- Does not need long-term anticoagulants after surgery.
- Leads to better function of the left ventricle.
- Has less risk of serious bleeding.
Repair may be done by reshaping the valve or removing
excess tissue, adding support to the valve ring, or attaching the valve to
other cordlike tissues in the heart (chordal transposition).
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. To help with this decision, see:
Heart Valve Problems: Should I Choose a Mechanical Valve or
Tissue Valve to Replace My Heart Valve?
If you receive a mechanical valve, you are more likely to develop blood
clots in the heart than if you received a tissue valve, so you will need
an anticoagulant medicine, such as warfarin, for the rest of your life. For more information about taking warfarin, see:
Warfarin: Taking Your Medicine Safely.
Surgery is usually delayed if no
symptoms or signs of heart failure are present. People with severe MR, no
physical symptoms, and whose
left ventricle is functioning normally may be
monitored every 6 to 12 months by their doctor. If follow-up testing shows
enlargement or abnormal function of the left ventricle, surgery is then usually
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.