Mitral Valve Repair

For people with dilated cardiomyopathy, the functions of the mitral valve, which connects the left atrium to the left ventricle, can be affected by the enlargement of the heart. The dilation of the heart can cause the opening to the mitral valve to expand beyond the size of the valve, keeping the mitral valve from closing properly. When this happens, blood can regurgitate back through the valve into the left atrium. Mitral valve regurgitation decreases pumping efficiency of the heart and can lead to the symptoms of heart failure.

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For some people with dilated cardiomyopathy, mitral valve repair improves the functioning of the heart muscle and can alleviate many of the symptoms of heart failure. Mitral valve regurgitation in people with dilated cardiomyopathy is treated during open heart surgery by either modifying the original valve and its opening or, in some cases, replacing the valve with a prosthetic heart valve.

Most surgeons agree that heart valves should be repaired when possible and replaced only when necessary. Valvuloplasty, or surgically modifying the original valve, can effectively eliminate regurgitation in some people. Surgeons can shorten or replace the cords that support the valves so that the cords and muscles are the right length and the valve leaflet edges meet, eliminating the leak. Alternatively, surgeons can make the ring of tissue surrounding the valve opening smaller, which allows the leaflets of the valve to close tightly, preventing regurgitation. Sometimes, surgeons will do this by implanting an annuloplasty ring. Surgeons can also repair the valve by removing excess tissue to help the valve close snugly.

In some cases, the mitral valve will need to be surgically removed and replaced with a prosthetic one--either a mechanical prosthetic valve or a bioprosthetic valve. The key to selecting the right prosthetic valve involves weighing the advantages and disadvantages of certain valves with the risk of anticoagulation therapy.

Mechanical prosthetic valves, made of synthetic materials, are more durable than tissue valves but require that a blood-thinning drug such as warfarin be taken for the rest of the person's life. People who take these drugs must have their blood tested regularly to ensure that their blood has not gotten too "thick" or "thin." Blood thinners are not recommended for people who play contact sports and pose risks for a developing fetus.

Bioprosthetic valves are made from animal tissue or human tissue taken from a donated heart and do not require blood thinners; however, they are not are not as durable as mechanical valves and may require replacement in about 10 years. In general, patients younger than 65 receive mechanical valves, while those over 70 receive bioprostheses. For some younger people, a bioprosthetic valve may be used with the understanding that additional surgery will be necessary in the future to replace it with a mechanical valve.