What are Mitral Valve Diseases?

• It most commonly occurs due to rheumatic heart disease (such as past rheumatic fever at a young age, etc.)
• Severe mitral annular or leaflet calcification (hardening of the leaflets)
• Congenital mitral valve anomalies (malformations)
• Endocarditis (valve infection)
• Left atrial (left atrium) thrombus, tumor in the left atrium
• Metabolic and carcinoid syndromes causing deformation
• Past commissurotomy procedures (past mitral valve surgery)
• Past mitral valve replacement (valve replacement)

• Mitral valve myxomatous degeneration (disorder of cartilage tissue)
• Rheumatic heart disease (such as rheumatic fever)
• Infective endocarditis (valve infection)
• Mitral annular calcification (calcification)
• Idiopathic (unknown cause) chordal rupture
• Ischemic (due to coronary insufficiency)”

Symptoms of mitral valve diseases may include shortness of breath, palpitations, arrhythmia, chest pain, fainting, leg swelling, coughing up blood, and an inability to lie flat on the back. Several of these symptoms may coexist, and their exacerbation is crucial during the surgical decision-making phase.

Patients presenting complaints to a cardiologist can have mitral valve diseases diagnosed through echocardiography and angiography. Patients not requiring surgery are monitored periodically through echocardiographic examinations. Sometimes, the diagnosis of valve diseases can be incidental during the investigation of another heart condition.

Mitral valve surgeries are diverse but can generally be classified into two categories:

1. Replacement
2. Reconstruction (Repair)

Mitral valve replacement: This involves removing the diseased valve and replacing it with mechanical or biological prosthetic valves. Mechanical valves are typically made of a rigid carbon material with surfaces that are nano-engineered to facilitate smooth blood flow, preventing clot formation in the circulatory system. However, regardless of the quality of the mechanical valve, the use of the blood-thinning medication Coumadin (Warfarin) is necessary after surgery. Mechanical valves work smoothly for years with the optimal adjustment of blood-thinning medications.

Biological valves, on the other hand, are produced from processed biological materials such as pig valves, bovine pericardium (heart membrane), or equine pericardium after laboratory processing. Biological valves tend to deteriorate more quickly compared to mechanical (metal) valves. The body recognizes the implanted biological valve as a foreign substance and begins to exhibit an immune reaction. Over the years, biological valves may undergo degeneration (decay), with varying timelines for this process. Since the mitral biological valve is stressed during systole (heart contraction), it tends to degenerate faster than the aortic biological valve. Generally, biological valves have lifespans ranging from 5 to 15-20 years, varying among individuals.

Mitral Valve Repair: If the cartilaginous structure of the mitral valve leaflets is minimally damaged, shows no signs of calcification, or if a leakage issue is solely due to heart enlargement, repair may be suitable. Repair, due to its advantages for the patient, is the most appropriate surgical method. After valve repairs, patients do not require blood-thinning medications, and the risk of bleeding, embolism (clot formation), or valve infection is almost negligible. Renowned cardiac surgeon Alain Carpentier (Paris, France) has been a pioneer in mitral valve repair, establishing an approach that has spread worldwide. Surgeons using his techniques have achieved highly successful surgeries for many years.

Both Mitral Valve Repair and Mitral Valve Replacement can be performed with small incisions. Typically, a 5 cm incision is made under the right chest or through the sternum, allowing the mentioned techniques to be applied.

The success rate of Mitral Valve Surgery varies between 97% and 99%. The primary risk factors for this surgery include delayed timing of the procedure, resulting in the development of pulmonary hypertension (pressure in the lungs), the onset of rhythm disturbances, the formation of clots in the heart, decreased pumping function of the heart (low EF), advanced age, and accompanying medical conditions.

Frequently Asked Questions (FAQ) About Mitral Valve Surgery