How Is Mitral Valve Prolapse Treated?

Goals of Treatment

The goals of treating mitral valve prolapse (MVP) are to:

• Prevent infective endocarditis, arrhythmias, and other complications
• Relieve symptoms
• Correct the underlying mitral valve problem when necessary

Who Needs Treatment

Most people with MVP don't need treatment because they don't have significant regurgitation of blood through the valve, and they have few or no symptoms. Even people who do have symptoms may not require treatment. The presence of symptoms doesn't necessarily mean that there is significant regurgitation through the valve. People with MVP and troublesome mitral valve regurgitation usually need treatment.

Specific Types of Treatment

MVP can be treated with medicine, surgery, or both.

Medicine

For people with MVP who have little or no regurgitation, medicines called beta blockers have been used to treat symptoms such as palpitations (strong or rapid heartbeats) and chest discomfort.

For people with MVP who have significant regurgitation and symptoms, the following medicines may be used to prevent complications:

• Vasodilators to widen the blood vessels and reduce the workload of the heart. Examples of vasodilators are isosorbide dinitrate and hydralazine.
• Digoxin to strengthen the heartbeat.
• Diuretics (water pills) to remove excess fluid in the lungs.
• Drugs such as flecainide and procainamide to regulate heart rhythms.
• Anticoagulants (blood thinners) to reduce the risk of blood clots forming in people with atrial fibrillation. Examples include aspirin or warfarin.

Surgery

Surgery on the mitral valve is done only when the valve is very abnormal and blood is regurgitating into the atrium. The main goal of surgery is to improve symptoms and reduce the risk for heart failure.

The timing of the surgery is very important. If it's done too early and your leaking valve is working fairly well, you may be put at needless risk from surgery. If it's done too late, irreversible heart damage may have already occurred.

Surgical approaches. The traditional surgical approach for mitral valve repair and replacement is through an incision in the breastbone to expose the heart. A small but growing number of heart surgeons are using another approach that uses one or more smaller incisions through the side of the chest wall. This approach can result in less cutting, reduced blood loss, and a shorter hospital stay, but it isn't available yet in all hospitals.

Valve repair versus valve replacement. In mitral valve surgery, the valve may either be repaired or replaced completely. Valve repair is preferred when possible. It's less likely to weaken the heart, lowers the risk of infection, and decreases the need for lifelong use of blood-thinning medicines.

If repair isn't an option, then the valve can be replaced. Two types of substitute valves are available: a mechanical valve or a biological valve.

Mechanical valves are made of man-made materials and can last a lifetime. Patients with mechanical valves must take blood-thinning medicines for life. Biological valves are valves taken from cows or pigs or made from human tissue. Many patients with biological valves don't need to take blood-thinning medicines for life. The major drawback of biological valves is that they weaken and often only last about 10 years.

After surgery, a patient usually stays in the intensive care unit in the hospital for 2 to 3 days. Most people spend about 1 to 2 weeks in the hospital. Complete recovery takes a few weeks to several months, depending on the person's health before surgery.

If you've had valve repair or replacement, you may need antibiotics before dental work and surgery that can allow bacteria into the bloodstream. These medicines can help prevent infective endocarditis, a serious heart valve infection. Talk to your doctor about whether you need to take antibiotics before such procedures.

Experimental approaches. Some researchers are testing the repair of leaky valves using a catheter inserted through a large blood vessel. While this approach is less invasive and can save the patient from having open heart surgery, it's only being done in a few medical centers. In addition, because it's a new procedure, it hasn't yet been shown in large studies to be better than traditional approaches.