Mitral valve replacement

S. Iswarya

Department of Echocardiography, Heart City, Trichy

Background

Mitral valve replacement is a form of heart surgery that replaces a leaking or narrowed mitral valve. Four heart valves regulate the flow of blood within the heart, including the mitral valve. The left upper and lower heart chambers are separated by it.

An open cardiac procedure may be used to replace the mitral valve. The approach used will depend on the severity and progression of the mitral valve disease.

When possible, surgeons typically advise mitral valve repair over replacement. It can preserve cardiac function and preserve the current heart valve.

Replacement of the mitral valve addresses the following conditions

Mitral valve regurgitation

Mitral valve regurgitation is the most common type of heart valve disease. In this condition, the valve between the chambers of the left heart does not close completely. Blood flows backwards across the valve. If the leak is severe, not enough blood is flowing through the heart or the rest of the body. Mitral valve regurgitation can cause severe fatigue or shortness of breath.

Possible causes of mitral valve regurgitation include

  1. Mitral valve prolapse
  2. Rheumatic heart disease
  3. Endocarditis(Inflammation of the inner lining of the heart’s chambers and valves)
  4. Radiation therapy
  5. Cardiomyopathy (Thickening of the heart muscle)
  6. Heart problem present at birth, also called a congenital heart defect.

Symptoms

Mitral valve regurgitation is often mild and develops slowly. Some people have no symptoms for years.

  1. Irregular heartbeat, called an arrhythmia.
  2. Shortness of breath, especially when lying down.
  3. Feelings of a rapid, pounding or fluttering heartbeat, called palpitations.
  4. Swollen feet or ankles.

Mitral valve stenosis

Mitral stenosis refers to the reduction in the size of the opening of the mitral valve. This condition limits the flow of blood from the left atrium to the left ventricle.

Possible causes of mitral stenosis include

Present at birth: This may be rarely congenital (at birth) mitral stenosis, usually detected around the age of 2 years. Such stenosis can range from mild to severe. Children with severe mitral stenosis usually do not survive past the age of 5 unless treated.

Damage from infections: Rheumatic fever is the leading reason for mitral valve narrowing. Frequently referred to as rheumatic mitral stenosis, this occurs when the immune system harms the valve during a battle against a left-untreated bacterial infection. The condition of rheumatic mitral stenosis deteriorates with time.

Wear and tear due to age: This type of stenosis is more likely to occur with age and is caused by a buildup of calcium in the valve. However, many people with age-related mitral stenosis have only mild to moderate narrowing and may not need treatment. Usually, calcification occurs naturally with aging, but certain conditions, such as kidney disease or radiation, can accelerate it.

Symptoms

Mitral valve stenosis typically gets worse gradually. He patient might not notice any signs, or could experience slight symptoms for a long time. Signs of mitral valve stenosis can appear at any age, including in early childhood.

  1. Swollen feet or legs
  2. Shortness of breath
  3. Sensations of a fast, fluttering or pounding heartbeat
  4. Dizziness
  5. Irregular heart sound, also called a heart murmur
  6. Fatigue, especially during increased activity
  7. Fluid buildup in the lungs
  8. Irregular heart rhythms
  9. Chest discomfort or chest pain
  10. Coughing up blood

Case presentation

Mitral valve replacement (MVR)

A 36-year- aged female consulted an Interventional cardiologist and was on regular checkups and follow-ups. She was diagnosed with RHD. Her echocardiogram revealed severe MS, moderate mitral regurgitation, chronic Atrial Fibrillation, mild Tricuspid Stenosis, mild and Tricuspid Regurgitation. In view of the below findings, the patient was advised  MV Replacement and TV repair

Pre-operative Echo

Diagnosis

  1. Rheumatic heart disease
  2. Severe MS (mitral valve gradient – 21/10 mmHg, mitral valve area – 1.3 cm2)
  3. Moderate Mitral regurgitation
  4. Mild TS
  5. Mild TR
  6. Mild LV dysfunction

Post-operative echo features

Diagnosis

  1. S/P MVR + TV repair
  2. Prosthetic valve movements and function normal
  3. Mitral valve gradient – 8/3 mmHg
  4. No para valvular leak
  5. Mild tricuspid stenosis/Mild – TR, PAH
  6. Mild LV dysfunction

Conclusion

The Mitral Stenosis (RHD) can cause many complications to the patient, therefore it needs immediate medical attention. The patient’s family showed complete faith in doctor’s advices and agreed for the surgery

The patient underwent successful mitral valve replacement on 16/05/2024 with good results. She was discharged within a couple of days and is now doing well in her life.

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