Re: Mitral valve repair

Posted By CCF CARDIO MD - CRC on September 11, 1998 at 10:06:02:

In Reply to: Mitral valve repair posted by Jennifer on August 14, 1998 at 22:23:08:






Thank you for this forum!  I am 29 and have known of my MVP for about 20 years.  My new PCP sent me to a cardiologist because I've had a recurring dizziness which is usually accompanied by extreme sleepiness for 7 years that has gone undiagnosed. The dizziness usually begins around lunchtime and can last all afternoon. A good nap cures it, but that's rarely possible.  After a stress test and echo, the dr suggests a heart cath then valve repair surgery.  He also suspects a leak between the atrium.  I went 8 minutes on the treadmill afterwards having a tightness in my throat.  The echo showed leakage or "backwash" into the pulmonary vein.  I was told that my MVP has worsened probably due to the birth of my 2 children.  Does MVP get worse?  What will the cath show?  Is surgery necessary if there is no other hole or leak besides the MVP?  I was told that people who have valve repair surgery come out feeling great, beforehand not realizing they were not living a normal life.  I DO realize that I don't have the stamina of most people.  I get out of breath going upstairs, am dizzy quite often or have a migraine.  Do you at the Clinic recommend valve repair surgery to everyone with MVP or is it only for those with certain problems?  I'd like a 2nd opinion and family and friends have recommended Henry Ford Hospital(MI). My cardiologist will not release the echo for my 2nd opinion.  I want to be certain that the 2nd dr will release all the info necessary if surgery is recommended. (My dr recommended your Clinic or U of M for surgery.) Can you comment on this-Henry Ford, 2nd opinions, and release of info? Any other comments would be appreciated.  THANK YOU!!  
Dear Jennifer,
Repair of the mitral valve vs. replacement with a bioprothesis or mechanical valve can only be determined in the operating room.  If the damage is not repairable then it is replaced.  The bioprothesis valve is from either a pig or cow and lasts about 10 years.  The advantage is that long-term anticoagulation is not required.  The disadvantage is that it will need replaced.  The mechanical valve (usually a St. Jude's) lasts for a lifetime but requires anticoagulation with coumadin. I have answered your other questions below.
Q: Does MVP get worse?
A: Yes,  MVP can worsen with time.  
Q: What will the cath show?
A: Cath is the "gold standard" to determine the degree of mitral regurgitation.
Q:  Is surgery necessary if there is no other hole or leak besides the MVP?
A: It may be necessary depending upon the degree of regurgitation.
Q: Do you at the Clinic recommend valve repair surgery to everyone with MVP or is it only for those with certain problems?
A: It is better to repair the valve if technically feasible.  

Q:  Will the shortness of breath go away, or is this a "side effect" of the damaged valve that can't
be treated?  
A: This should go away when the valve is repaired.
Q:  For the surgery, do you have to crack open the rib cage to get to the damaged area? On
average, how long does the surgery take? -
A: Some surgeons are performing "mini" mitral valve repairs where a smaller incision is used and the breast bone is not cracked.  The use of this approach will depend upon the specific case.  Surgery usually takes from 2 to 4 hours.
Q: How long (approximately) is recovery time?
A: Usually 5 to 7 days in the hospital and 4 to 6 weeks at home.
Q:  Are there any dietary or other restrictions before/after the surgery we should know about? -
A: Limit salt intake to help cut down on fluid overload.  Otherwise no restrictions except what your doctor tells you.
Q: Statistically, how many patients diagnosed with mitral valve disorders are treated with repair versus replacement surgeries, and what are some of the advantages/disadvantages to both types of surgeries?
A: See above discussion. About 85% of persons with Mitral Valve Prolapse (different condition than endocarditis) will get repair.  For other surgery it will depend on the valve.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist