Common pitfalls in treating mitral valve problems
The following concerns apply to both mitral valve stenosis and mitral valve regurgitation. A concern specific to either condition will be noted.
Failure to replace the valve before permanent damage occurs
Because a mitral valve problem can eventually cause irreversible damage to your heart, it is important that you have your valve repaired or replaced before it causes permanent damage. If you wait too long to repair or replace your valve, the surgery may not substantially improve your heart function. The following recommendations are from the American College of Cardiology and the American Heart Association (ACC/AHA).1 These recommendations are also followed in Canada.
- For mitral valve stenosis, you should have surgery to repair or replace your mitral valve if your valve area drops below 1.5 cm2 and you have serious, life-limiting symptoms. If you delay surgery, your mitral valve may not be able to be repaired.
- For mitral valve regurgitation, you may need valve surgery before you have symptoms. You should have mitral valve surgery when your ejection fraction drops below 60% and/or your left ventricle is dilated more than 40 mm at rest. Although many people do not have any symptoms at this early stage of the disease, having surgery on the valve before symptoms occur can prevent irreversible heart damage.
Failure to treat multivalvular problems during surgery
It is important that you treat any valve problems you have with one surgery. Treating one valve problem and leaving others will not alleviate all of the stress placed on your heart from valve problems. This means the damage that is being done to your heart will continue. This damage can have a serious negative effect on your chances for survival immediately after surgery.
After years of being affected by multiple valvular disease, your heart has adjusted to the combination of valve problems and has compensated for the malfunctions to the best of its ability. When you fix one valve and not another, the blood is still flowing incorrectly through your heart, and your heart has not had time to compensate accordingly. This can create new heart problems, which may be even harder to cope with than your original multiple valve problems.
Valve surgery is a major procedure during which you are placed under anesthesia, your chest is opened, and surgeons operate on your exposed heart. This surgery places considerable stress on the body, and you want to minimize the number of times you have open-heart procedures. Correcting more than one valve problem in one operation may eliminate the need for you to have additional open-heart surgeries.
Failure to treat other conditions simultaneously
Valve problems often occur in conjunction with other diseases of your circulatory system, including coronary artery disease (CAD). It is important that your treatment be tailored to address both your valve problem and other conditions you may have. Otherwise, you run an increased risk of developing heart failure. In addition, as explained above, open-heart surgery is an extensive procedure that places substantial strain on the body. If you need surgery to correct mitral valve stenosis as well as CAD (or other heart condition), it will be to your benefit to have these surgeries done at the same time.
Ineffective/insufficient monitoring of the condition
After you have been diagnosed with a mitral valve problem, it is important that your condition be monitored periodically for changes. This monitoring should take place regularly and should utilize tests that allow your doctor to accurately assess your condition.
- For those with mitral valve stenosis, this test must assess the valve area and the pressure gradient across your mitral valve.
- For those with mitral valve regurgitation, this test must assess the ejection fraction.
If the test does not allow your doctor to assess these valve functions, your doctor may not catch a worsening of the valve function. Your heart has an amazing ability to compensate even when a valve is malfunctioning.
Not monitoring regularly or not performing the right tests can cause two problems. First, it may be difficult to measure changes in your condition if you do not have a recent reading with which to compare a new reading. Also, insufficient monitoring could allow your condition to develop to a critical point before it is noticed and treated.
Failure to report symptoms
It is extremely important that you report to your doctor all symptoms or changes in your symptoms. Your doctor will rely on you to provide an accurate assessment of how you feel and how your symptoms have changed since your last visit. Even if an issue seems unimportant to you, you should mention it so that your doctor can assess it in light of your condition and overall health. Without your help, your doctor may miss important signs that signal important changes in your condition.
| Author: | Douglas Dana Robin Parks, MS | Last Updated: May 9, 2008 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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