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. |