Valve repair and replacement is performed to improve the blood flow through a faulty valve. Although any valve in the heart can be repaired or replaced, the vast majority are performed on the mitral valve located on the left-side of the heart between the left atrium and left ventricle.
Valve Disease: The problem
In healthy patients, blood returning from the lungs enters the left atrium (the left upper chamber of the heart) and through the mitral valve into the left ventricle (the left lower chamber of the heart). From the left ventricle, the blood is pumped through the aorta and out to the rest of the body.
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In the hearts of patients with valvular disease, the mitral valve doesn't open or close properly. Patients with valves that interfere with adequate blood flow may notice a number of symptoms that compromise the quality of their daily lives, including:
Valve disease compromises blood flow in one of two ways:
Stenosis
In stenotic valves, the leaflets that make up the valve stiffen. This narrows the valve opening and prevents smooth blood flow. This can cause dangerous increases in pressure within the heart and lungs.
Regurgitation
Regurgitation occurs when one or more of the leaflets enlarges or tears to the point the valve can no longer close with a tight seal, allowing blood to flow back through the valve once its been pumped through. This condition is sometimes referred to as floppy valve syndrome.
There are a number of causes for this kind of wear and tear on the valve, including mitral valve prolapse, valve infections, and myxomatous degeneration.
How are valve repairs performed?
The procedure for valve repair depends on the particulars of a patient's case. For example, a patient suffering from a narrowed valve would receive valve commissurotomy during which a surgeon would either stretch or cut into the leaflets or replace the valve. A patient with a floppy valve would receive valvuloplasty to tighten the seal and remove the abnormal valve tissue. At times, complex valve repair includes leaflet transfers.
In all cases, surgeons at Montefiore-Einstein Heart Center offer patients the most minimally invasive approach available. Depending on the circumstances, Montefiore-Einstein's surgeons will use breast bone incisions that are up to two-thirds smaller than the traditional cut. Alternatively, surgeons are able to perform valve repair through an incision between the ribs.
Repair vs. replacement
Although Montefiore-Einstein offers cutting edge procedures for the full spectrum of mechanical and biological valve replacement, surgeons at Montefiore-Einstein are dedicated to valve repair as a primary option. Since some patients who undergo valve replacements must take blood thinners, such as Coumadin, for the rest of their lives or pig/cow valves may "wear out," Montefiore-Einstein surgeons focus on repairing the native valve.
When the valve is repaired, patients maintain their own tissue and don't need to take blood thinners. This is an attractive option for young women planning to become pregnant. Montefiore-Einstein repairs the valves of more than 90 percent of its patients with mitral valve regurgitation.
Protecting your valves during routine medical procedures
Infections that affect valve function cross every social and economic line—they can happen to anyone. Patients who have existing valve conditions are at risk for contracting an infection during routine dental, OB/GYN, and urology procedures where there is a risk of bacterial release into the bloodstream.
Patients with existing valve conditions should talk to their doctors about taking antibiotics before these routine procedures. For example, your doctor may prescribe an oral antibiotic to be taken prior to dental work.
Teaching the next generations of surgeons
Recently, the American College of Cardiology asked Dr. Robert Michler, Chairman of Montefiore-Einstein's Department of Cardiothoracic Surgery, to submit a chapter on minimally invasive valve repair and a video lecture that includes narrated footage of Dr. Michler performing a minimally invasive valve repair both with and without robotic assistance. These educational videos will be used for continuing education training for cardiologists and heart surgeons throughout the world.
© 2008 Montefiore Medical Center
