How should mitral valve abnormalities be treated?
Heart valve disease is a condition where any of the four valves in the heart do not function properly to regulate the forward flow of blood through the heart chambers and to the body, leading to a back flow.
Faulty heart valves should be treated as they could lead to complications or even heart failure, which could be fatal.
When heart valve disease is suspected, an echocardiography is the first investigative step a cardiothoracic surgeon will recommend. The treadmill test and angiogram come later when the patient needs surgery.
- Echocardiography – an ultrasound imaging of the heart chambers and the heart valves. Any abnormalities can be detected quite accurately this way.
- Treadmill exercise testing – tests the heart at high workload to detect any ECG abnormalities at a high heart rate. The ECG reading will be abnormal if coronary artery disease has narrowed the coronary arteries.
- Coronary angiography – an invasive test where a small catheter or tube is inserted into the arterial system, either through the radial artery of the arm, or the femoral artery in the groin, with X-ray guidance. A liquid dye is injected to make the blood flowing in the coronary arteries visible on X-ray. Any blockages or narrowing will show up here.
If these tests indicate mitral valve disease, treatment will depend on the severity of the condition and symptoms. If the valve abnormality is considered mild to moderate, with no serious effects on the patient, the condition can be monitored. Serial echocardiography will be conducted every six months to look for possible progression.
If treatment is necessary, the doctor may start these medications to address the symptoms of the heart valve disease:
- Blood pressure and heart-rate control medications. Reducing the heart rate and blood pressure improves the efficiency of the heart by reducing afterload.
- Diuretics reduces the amount of fluid in blood, relieving effects of heart failure.
- Blood thinners are prescribed only when there is atrial fibrillation, which is an abnormal heart rhythm associated with strokes.
If mitral valve disease is severe, surgery is recommended:
- To repair the mitral valve
- To replace the valve using a mechanical valve, or a biological valve made with animal tissue.
Mechanical valve replacement will require the patient to take blood thinning medication for the rest of his life. Blood thinning medication is not needed for biological valve replacement recipients, but such valves will only last 12 to 15 years.
Surgical procedures to repair or replace mitral valves include open-heart surgery. Another method is to attach clips, plugs or other devices to a catheter, and insert it through an artery in the groin to reach the mitral valve.
After mitral valve treatment, patients will be advised to manage their stress level, adopt a heart-healthy diet and incorporate a fitness regime in their daily routine.
This article has been fact-checked by Dr Lim Chong Hee, consultant cardiothoracic surgeon at Surgi-TEN Specialists, Farrer Park Hospital.