Depending on your condition and symptoms, your doctor may recommend:
- Mitral Valvuloplasty
- Surgical Treatments
To learn about the various treatment options for mitral valve stenosis, keep reading.
Medications for Mitral Valve Stenosis
If tests show minor or moderate narrowing of the mitral valve, your cardiologist may recommend monitoring your condition during regular check-ups. Some people never require replacement or repair of their mitral valve because they never develop severe mitral stenosis.
If you experience symptoms, your doctor may prescribe medications to provide relief. These medications may include:
- Diuretics: Drugs that help reduce fluid accumulation in your body by increasing fluid loss through urination
- Blood thinners (anticoagulants): Drugs that help prevent blood clots from forming
- Anti-arrhythmics: Drugs to control an irregular heartbeat, such as the too-fast heart rhythm of atrial fibrillation (AF)
- Antibiotics: Drugs to prevent bacterial infection of your heart valve, which you need to take before surgery or teeth cleaning
Even if you are taking medications, you may notice an increase in fatigue or shortness of breath. If this occurs, you should let your doctor know immediately.
To learn more about medications that doctors prescribe for heart valve problems, click here.
Mitral Valvuloplasty for Mitral Valve Stenosis
Mitral valvuloplasty is a non-surgical procedure that may be used to open a narrow valve within the heart.
The procedure can be performed on the same day of admission to the hospital and although some patients may be discharged at the end of the day, people usually stay the night in the hospital. People who take the blood thinner Coumadin must be switched to the short-acting blood thinner Lovenox (which is injected like insulin) or admitted to the hospital two days in advance for intravenous blood-thinner therapy with heparin.
A special echocardiogram (ultrasound of the heart) will be performed the morning of, or in the weeks prior to, the procedure. This test is called a transesophageal echocardiogram. The patient is put to sleep with medication and a small ultrasound probe is passed down the swallowing tube (esophagus). The heart structures are then viewed through the wall of the esophagus. This is not a painful procedure because the individual is asleep during the test. It is a very important test because it detects any blood clots that are in the heart. If a blood clot is found, the valvuloplasty usually will not be performed because the risk of causing a stroke would be too high.
The valvuloplasty procedure is done in the cardiac catheterization lab using x-ray and a dye that is injected into the bloodstream. Local anesthetic (numbing medicine) is given in the crease of both legs before the tubes are placed into the blood vessels in that area. Once the numbing medicine has taken effect, there should only be a sensation of pressure while the tubes are placed. Intravenous medicine for relaxation is usually given, so that a person may doze off to sleep during the procedure. Patients are not put into a deep sleep, however, so that they can talk to the doctor during the procedure.
A soft plastic tube (catheter) is passed through the bloodstream up to the heart where pressure measurements are taken, and the arteries of the heart are visualized. This does not cause pain because there are no nerves inside those blood vessels. Once the measurements are taken, a tiny needle is used within the heart to cross from the right side into the left side. The two sides of the heart are separated by a muscular wall, which is crossed with the tiny needle. The valvuloplasty balloon is passed through the wall and positioned across the narrow mitral valve. The balloon is quickly inflated and deflated within the valve to stretch the valve open. This may be performed two or three times. During balloon inflation, a person may feel warmth or flushing in the face or chest, pressure in the chest or mild chest discomfort. This usually passes in 5 to 10 seconds. When the procedure is finished, all of the tubes and the balloon are removed from the bloodstream and pressure is applied to the site in the crease of the leg to prevent bleeding. Bed rest for a few hours after the procedure is important to prevent bleeding.
Risks Associated with Mitral Valvuloplasty
The doctor and nurse will discuss risks in detail with all patients. Those risks include:
- Bleeding: There is a small risk of bleeding from the site where the tubes enter the skin. The sites may be closed with a "stitch" or a "glue plug" or may be held by manual pressure after tubes are removed. Bed-rest is necessary for a few hours after the procedure to reduce the chance of bleeding. In a rare situation, a blood transfusion or surgery to repair a damaged blood vessel in the leg may be necessary.
- Stroke, heart attack, allergy or kidney injury: There is a small risk of a stroke, heart attack, allergy or kidney problems related to the intravenous dye, irregular heart rhythm and rarely death.
- There is a small chance that the procedure will not improve the opening of the valve. In that case the doctor may discuss scheduling open-heart surgery to replace the valve in the following weeks or months.
- Valve damage: There is a small chance that the balloon may damage the valve, which would require open-heart surgery to replace the valve, possibly even that same day; this occurs with approximately 3 in 100 patients.
Before Mitral Valvuloplasty
It is important not to eat or drink anything after midnight the night before the procedure. Medications are usually taken with sips of water during that time, but specific instructions are given to each person beforehand. Those individuals who have an allergy to the intravenous dye must tell the doctor or nurse so that medication to prevent a reaction can be prescribed. People taking blood thinners will be instructed when to stop prior to the procedure.
Patients are asked to report to Ambulatory Surgery a few hours prior to the procedure. Glasses, dentures and hearing aids are permitted during the procedure.
Surgical Treatments for Mitral Stenosis
Depending on your condition, your cardiologist may recommend surgery to repair or replace a narrowed mitral valve.
Before surgery, you will receive a general anesthetic, which is a medicine that puts you into a deep sleep during the procedure. Your doctor will make a cut (incision) along the length of the flat bone in the center of your chest (breastbone) to expose your heart. You will be connected to a heart-lung machine, which will take over your breathing and blood circulation during the surgery. The surgeon will stop your heart, make a cut in it to expose the valve and then repair or replace the valve.
Mitral Valve Repair
Surgery to repair the mitral valve may be an option in rare cases of mitral stenosis. Improved blood flow through the valve can be accomplished by surgically separating the valve’s leaflets, removing tissues that obstruct the valve or making adjustments to the fibers (chords) that hold the base of the valve’s flaps to the heart.
A valve repair may not last or be successful and may need to be repeated.
Mitral Valve Replacement
If your valve cannot be repaired and it must be replaced, your surgeon will implant an artificial (prosthetic) valve. An artificial valve can be made of metallic or tissue components.
Mechanical valves are devices made of metallic materials, such as titanium. They offer life-long durability. The main risk with mechanical valves is blood clot formation (thromboembolism). In order to prevent blood clots after receiving a mechanical valve, you will need to take blood-thinning medications for the rest of your life.
A secondary risk is associated with taking the blood-thinning medications. Blood-thinning medications increase the risk of bleeding. If the drugs make the blood too “thin,” you can experience excessive bleeding, even with minor cuts. If the blood is too “thick,” clots can form on the valve. A clot could later break off and lodge in the blood vessels to the heart or brain, blocking blood flow and leading to heart attack or stroke.
Careful monitoring to ensure the correct levels of anti-coagulation medications is critical. It may require a monthly visit to the doctor’s office. New home monitoring units may make it possible to regulate your blood levels without going to the doctor’s office.
Tissue valves are made of valve tissue taken from a cow (bovine), pig (porcine) or human cadaver (homograft). Because they do not encourage blood clot formation, patients who receive tissue valves do not need to take blood-thinning medicines.
However, tissue valves have not historically been as long-lasting as mechanical valves. A tissue valve (bioprosthetic) can wear out over a period of 10 to 15 or more years. If it deteriorates significantly, it must be replaced. Replacement, of course, requires repeat surgery. Because of durability concerns, tissue valves are implanted primarily in older patients. However, tissues valves have improved steadily and are being used more and more frequently.
Risks of Surgical Treatment
As with any medical procedure or surgery, there are risks associated with heart valve surgery. As always, it is important to talk with your care team about your treatment options and the benefits and risks that are associated with each option. The main risks associated with heart valve surgery include --
- Death. The overall mortality risk (risk of death) for heart valve surgery is less than 5 percent.
- Irregular heart beat (arrhythmia). Arrhythmias can make you tired or short of breath and put you at risk of blood clots. You may need to take blood-thinning medications to lower the risk of blood clots, which may form in the heart due to an irregular heartbeat.
- Infection. After valve surgery, you may be prone to an infection or inflammation of the heart valves (endocarditis). It occurs when bacteria enter the bloodstream and infect damaged valve leaflets. People who have abnormal or damaged heart valves or who have received an artificial heart valve are more vulnerable to the infection.
- Risks associated with being put to sleep with general anesthesia.
- Risks associated with surgery, such as bleeding.
Recovery After Mitral Valve Surgery
After mitral valve surgery, recovery in the hospital may last from 4 to 10 days, depending on your condition. You may spend the first days after surgery in an intensive care unit (ICU), where your heart will be closely monitored.
While in the ICU, you may have a number of tubes in your body to help recovery, including tubes to help you breathe, to drain fluids from the stomach while you are not eating, to drain fluid from your chest, to empty your bladder and to measure blood pressure. These tubes will be removed when you are moved out of the ICU to another care unit.
You will receive therapy to prevent complications such as pneumonia, collapsed lung or infection. A nurse or therapist may lead you in deep breathing exercises and coughing and encourage you to move your legs to lower the chance of blood clot formation. Your therapy may also include gentle patting on the back to loosen fluids in the lungs.
Physical therapy will also be part of the recovery process. In the hospital, you will be encouraged to walk around and you will be shown how to move your arms without hurting your breastbone. You will also learn how to do daily activities in ways that will not interfere with the healing process.
If you have heart valve disease, it is important to understand your condition so that you can work closely with your healthcare team to develop a long-term plan for your care. We invite you to check out the SecondsCount Valvular Heart Disease Center. In this center, you’ll find information on additional resources to turn to, as well as tools to help you track your medications.