Mitral Valve Stenosis: Repair or Replacement?
If you have mitral valve stenosis and you need surgery to treat it, you have a choice of repairing the valve or replacing it. Many things play a role in this decision. These things include whether you have symptoms or other health problems (or both), the severity of your mitral valve stenosis, the shape of the mitral valve, and the risks of surgery.
What factors play a role in the decision?
When making this decision, you and your doctor need to consider:
- The severity of mitral valve stenosis. The severity is based on many things, including the shape of the mitral valve, how well blood is flowing through the valve, and if you have symptoms.
- The condition of the valve and what is causing the stenosis. The more severe the stenosis, the more likely replacement will be needed.
- The surgeon's skill and experience in doing the procedures. Both valve replacements and balloon valvotomies are highly technical and should be done by an experienced surgeon.
- Whether you have a blood clot in your left atrium.
- Whether you have atrial fibrillation.
- Whether you are going to have surgery for another heart problem.
Your symptoms and the area of your mitral valve determine how severe your mitral stenosis is: the smaller the area, the lower the volume of blood that is able to pass through it, and so the more severe your stenosis. The pressure difference between your left atrium and left ventricle, as well as the blood pressure in your lungs, is also used to assess severity.
When is mitral valve repair recommended?
Generally, mitral valve repair is preferred if:
- Your valve is suitable for it.
- Your surgeon has the appropriate level of experience and surgical skill.
The advantages of mitral valve repair are that it:
- Preserves your natural valve.
- May have fewer risks than mitral valve replacement surgery.
The disadvantages of mitral valve repair are that:
- Not all valve problems can be repaired.
- The repair may not last and then you may need valve replacement surgery.
A balloon valvotomy is typically preferred over mitral commissurotomy as long as the doctor is experienced with the procedure. The two procedures have similar rates of success. A balloon valvotomy is a minimally invasive catheter procedure. A commissurotomy repair is typically an open-heart surgery using a heart-lung bypass machine.
When is mitral valve replacement recommended?
Valve replacement surgery might be done if the valve is damaged beyond repair. Replacement might also be considered if you are already going to have another type of heart surgery.
Other Works Consulted
- Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Current as ofApril 3, 2017
Current as of: April 3, 2017
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