Mitral Valve Insufficiency: Surgical Options and Definitions Explained

Mitral valve insufficiency

Hello, doctor.
I experienced sudden shortness of breath last December, which made me want to breathe through my mouth, but it felt like I wasn't getting enough air.
I later visited a pulmonologist who arranged for pulmonary function tests and an electrocardiogram, both of which came back normal.
However, I still felt some chest discomfort, so I consulted a cardiologist who ordered an echocardiogram and Doppler flow study.
The results indicated moderate to severe mitral valve regurgitation, and surgery may be necessary.
I later obtained my medical records, which state that the diagnosis is non-rheumatic mitral valve prolapse.
Doctor, if surgery is required, is there a possibility for a repair procedure? Additionally, could you explain the meanings of secondary and primary? Thank you.

Hong XX, 30~39 year old female. Ask Date: 2020/02/24

Dr. Cai Guiqin reply Cardiology

It is advisable for you to discuss your condition further with your attending physician.
Wishing you good health!

Reply Date: 2020/02/24

More Info

Mitral valve insufficiency, also known as mitral regurgitation, occurs when the mitral valve does not close properly, allowing blood to flow backward into the left atrium when the left ventricle contracts. This condition can lead to various symptoms, including shortness of breath, fatigue, and palpitations, particularly during exertion. Given your history of sudden shortness of breath and the findings of moderate to severe mitral valve insufficiency, it is crucial to understand the surgical options available and the definitions of primary and secondary mitral valve insufficiency.

Surgical Options for Mitral Valve Insufficiency
1. Mitral Valve Repair: This is often the preferred surgical option when feasible. Repairing the valve can involve techniques such as:
- Annuloplasty: Tightening or reinforcing the ring (annulus) around the valve to help it close properly.

- Chordal Replacement: Replacing or repairing the chordae tendineae, which are the fibrous cords that connect the valve leaflets to the heart muscle.

- Leaflet Reshaping: Reshaping or removing portions of the valve leaflets to improve closure.

Repairing the mitral valve is generally favored over replacement because it preserves the patient's own valve structure, often resulting in better outcomes and fewer complications.

2. Mitral Valve Replacement: If the valve is too damaged to repair, a replacement may be necessary. There are two main types of replacement valves:
- Mechanical Valves: Made from durable materials, these valves can last a lifetime but require lifelong anticoagulation therapy to prevent blood clots.

- Biological Valves: Made from animal tissues, these valves may not last as long as mechanical valves but typically do not require long-term anticoagulation.

Definitions: Primary vs. Secondary Mitral Valve Insufficiency
- Primary Mitral Valve Insufficiency: This refers to conditions that directly affect the mitral valve itself, such as degenerative diseases (e.g., mitral valve prolapse), rheumatic heart disease, or infective endocarditis. In your case, the diagnosis of non-rheumatic mitral valve prolapse suggests that the valve's structure is inherently abnormal, leading to insufficiency.

- Secondary Mitral Valve Insufficiency: This occurs when the mitral valve is structurally normal, but its function is compromised due to changes in the heart's anatomy or function. Conditions such as left ventricular dilation or hypertrophy, often due to ischemic heart disease or hypertension, can lead to secondary mitral regurgitation. In these cases, addressing the underlying heart condition may improve mitral valve function.

Conclusion and Next Steps
Given your diagnosis of moderate to severe mitral valve insufficiency due to non-rheumatic mitral valve prolapse, surgical intervention may be warranted, especially if you are experiencing significant symptoms like shortness of breath. A thorough evaluation by a cardiothoracic surgeon specializing in valve surgery will help determine whether repair or replacement is the best option for you.

It is essential to discuss your symptoms, surgical options, and any concerns you may have with your healthcare provider. They can provide personalized recommendations based on your specific condition, overall health, and lifestyle. Regular follow-up appointments and echocardiograms will also be crucial in monitoring your heart function and the progression of your mitral valve insufficiency.

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