MITRAL VALVE
is a heart valve that lies between the left atrium and left ventricle. The valve has two flaps (cusps). The valve allows blood to flow into the left ventricle when the left atrium squeezes (contracts). When the left ventricle contracts, the valve closes and the blood flows out through the aortic valve into the aorta. (The aorta is the main artery which takes blood to the body.)
Mitral stenosis means that when the mitral valve opens, it does not open fully. The opening is therefore narrower than normal (stenosed)
MITRAL REGURGITATION
Symptoms
Mild mitral regurgitation may not cause any symptoms. However the symptoms associated with more severe mitral regurgitation include:
- Shortness of breath, especially with activity or when you lie down
- Tiredness
- Heart palpitations
- Swollen ankles (oedema)
Treatment
Mild cases may not require any regular medication. Although medicines cannot correct mitral regurgitation, some medicines may be prescribed to help ease symptoms, or to help prevent complications – for example, angiotensin-converting enzyme (ACE) inhibitors, ‘water tablets’ (diuretics) and anticoagulation medication. If you develop atrial fibrillation, several medicines can be used to slow the heart rate down.
Surgical treatment
Surgical treatment is sometimes needed. Recent guidelines favour surgery at an earlier stage than used to be the case.
Valve repair may be an option in some cases.
Valve replacement is needed in some cases. This may be with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with your body, such as titanium. Tissue valves are made from treated animal tissue, such as valves from a pig.
Recent guidelines favour replacement rather than repair in many cases. If you need surgery, a surgeon will advise on which is the best option for your situation.
AORTIC STENOSIS & Aortic Regurgitation
The aortic valve is a heart valve that lies between the left ventricle and the aorta.
Aortic stenosis
Aortic stenosis means that when the aortic valve opens, it does not open fully. The opening between the left ventricle and the aorta is therefore narrowed (stenosed).
As a result, the amount of blood that can pass from the left ventricle to the aorta is reduced. The more narrowed the valve, the less blood can get through and the more severe the problem is likely to be.
In some cases, aortic stenosis occurs at the same time as aortic regurgitation.
Symptoms
Mild aortic stenos may not cause any symptoms. However the symptoms associated with more severe aortic stenosis may include:
- Chest pain (angina) or tightness with activity
- Feeling faint or dizzy
- Shortness of breath, especially with activity
- Tiredness
Treatment
Medication may be advised to help ease symptoms of heart failure if heart failure develops – for example, angiotensin-converting enzyme (ACE) inhibitors and/or ‘water’ tablets (diuretics). See separate leaflet called Heart Failure for more details on treatment methods.
Surgical treatments
An operation to fix aortic stenosis is a commonly done procedure. It has a very good chance of success. If you need surgery, a surgeon will advise on which is the best option for your situation. The possible options include the following:
- An operation to widen the valve (valvotomy):This requires open heart surgery.
- Open heart surgery to replace the valve :The replacement may be with a mechanical or a tissue valve.
Mechanical valves are made of materials which are not likely to react with your body, such as titanium.
Tissue valves are made from treated animal tissue.
- Transcatheter aortic valve replacement (TAVR)
Plastic tubes (catheters) are inserted into the heart through various arteries. Using these tubes, an artificial valve is sited within the existing aortic valve. This procedure does not require open heart surgery.
- Stretching the stenosed valve (balloon valvuloplasty)
This is an option that is sometimes considered. This also does not require open heart surgery.
A catheter is inserted into the main blood vessel in the top of the leg. It is passed up to the heart. The tip of the catheter is placed in the aortic valve opening. A balloon at the tip of the catheter is then inflated to stretch the narrowed valve.
However, for adult patients, balloon valvuloplasty tends to be used only in those who are unsuitable for valvotomy or valve replacement surgery. This is because the improvement in the flow across the valve (following balloon valvuloplasty) does not usually last for very long. Valvotomy or valve replacement surgery tends to give better long-term results.
Aortic Regurgitation
Aortic Regurgitation is sometimes called aortic incompetence or a leaky aortic valve. In aortic regurgitation the valve does not close properly. The aortic valve is a heart valve that lies between the left ventricle and the aorta. Therefore, blood leaks back (regurgitates) into the left ventricle from the aorta.
Symptoms
Mild aortic regurgitation may cause no symptoms.
However symptoms may include:
- Tiredness
- Weakness
- Shortness of breath, especially with exercise or when you lie down
- Lightheadedness or fainting
Treatment
If the backflow of blood is mild then you may not need any treatment. If you develop complications, various medicines may be advised. Surgery may sometimes be advised.
Medication- Medication may be advised to help ease symptoms of heart failure if heart failure develops – for example, angiotensin-converting enzyme (ACE) inhibitors and/or ‘water’ tablets (diuretics). See separate leaflet called Heart Failure for more details on treatment methods.
Surgery- Surgical options include repair of the aortic valve or replacement of the valve. The most recent guideline recommends replacement as the preferred option in most cases.
Valve replacement surgery may be with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with your body, such as titanium. Tissue valves are made from treated animal tissue, such as valves from a pig. If you need surgery, a surgeon will advise on which is the best option for your situation.
Surgical treatment has greatly improved the outlook in most people with more severe regurgitation. The outlook (prognosis) is good if the valve is treated before the heart becomes badly damaged.
Publications
- Valve disease types. (2015). my.clevelandclinic.org/health/diseases/17600-valve-disease-types
- Heart valve disease. (n.d.). surgery.ucsf.edu/conditions--procedures/heart-valve-disease.aspx
- Heart valve disease. (n.d.). nhlbi.nih.gov/health-topics/heart-valve-disease
- Heart valve diseases. (n.d.). hopkinsmedicine.org/healthlibrary/conditions/adult/cardiovascular_diseases/heart_valve_diseases_85,P00210/
- Bicuspid aortic valve disease. (2015). my.clevelandclinic.org/health/diseases/16780-bicuspid-aortic-valve-disease/treatment-options