If medicines are not effective in controlling your symptoms of mitral valve stenosis or if your doctor determines that you need more aggressive treatment, you may need surgery to repair or replace your mitral valve. While valve surgery is common and usually successful, a degree of risk is associated with this invasive procedure. There are generally three options: a balloon valvotomy, a closed (or open) commissurotomy surgery, or valve replacement surgery.

Valve repair (balloon valvotomy)

Balloon valvotomy (percutaneous mitral balloon valvotomy) is the method of choice for treating mitral valve stenosis in select patients. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, so recovery is easier.

A balloon valvotomy is usually recommended if you have symptoms, moderate to severe stenosis, and most of your mitral valve is a normal shape.²

Your doctor will measure your pressure gradient and valve size to determine how bad the stenosis is. A normal mitral valve has an opening between 4 cm² and 5 cm².

A balloon valvotomy may also be used to treat people with mitral valve stenosis who do not yet have symptoms (asymptomatic) if they have:²

• A higher risk of dangerous blood clots (thromboembolism). This includes people with an irregular heart rhythm called atrial fibrillation, as well as those who have had a blood clot before.
• High blood pressure in the lungs (pulmonary hypertension).
• Mitral valves that are still in fairly good condition.

Your doctor may recommend a balloon valvotomy if you are planning to have another surgery (not on your heart), if you are pregnant, or if you are planning a pregnancy.

People with signs of blood clots in the left atrium, widespread calcification of the mitral valve structures, or moderate to severe mitral valve regurgitation are not considered good candidates for a balloon valvotomy.²

The mitral valve may narrow again (restenosis) after 10 to 20 years.

Valve surgery

Depending on the amount of damage to your mitral valve, your doctor may recommend surgery to repair or replace your mitral valve. If the valve is damaged beyond repair, it will need to be replaced. Mitral valve surgery may be done as an open-heart surgery, or a minimally invasive surgery.

During open-heart surgery, your heartbeat is stopped, and you are placed on a heart-lung machine to deliver blood to your body. The heart-lung machine temporarily serves in place of your heart and lungs by mixing oxygen with the blood, removing carbon dioxide from the blood, and pumping the blood throughout your body.