Mitral Valve Disease

The mitral valve performs an important role in your heart as it controls the flow of blood going in one direction from the lungs to the body. If the mitral valve, located between the heart's left upper chamber (left atrium) and the left lower chamber (left ventricle), does not close properly, or open completely, the heart may have to work twice as hard to do its job, which can lead to life-threatening heart conditions.

Illustration showing normal mitral valve open and closed

Normal mitral valve function

Mitral Valve Expertise and Successful Outcomes

The mitral valve specialists at the University of Michigan Frankel Cardiovascular Center have successfully repaired thousands of mitral valves. Our high volume translates to extensive experience in the operating room and better outcomes for our patients.

The Frankel Cardiovascular Center is home to one of the largest mitral valve practices in the country focused on mitral valve repair, which has better long-term outcomes than mitral valve replacement, including better long-term survival rates, better preservation of heart function and lower risk of complications.

The average number of isolated mitral valve repair surgeries per surgeon in the U.S. is 5 per year. That’s approximately 150 surgeries per career. We do more than 200 mitral valve repairs per year. In fact, our director alone has performed more than 4,000 mitral valve surgeries to date. And, in the U.S., while the degenerative mitral valve repair rate is 41percent, our repair rate is more than 95 percent.

Types of Mitral Valve Disease

Illustration showing normal mitral valve and mitral valve with stenosis

Millions of people in the U.S. are diagnosed with mitral valve disease every year. Mitral valve disease can be characterized by mitral valve stenosis and mitral valve regurgitation.

  • Mitral valve stenosis occurs when the flaps or leaflets of the valve thicken, stiffen or fuse together. This results in a narrowing of the valve and prevents the valve from fully opening, restricting the blood flow through the valve. The main cause of mitral valve stenosis is rheumatic fever, which is more common in developing coutries but is still seen in the United States. Mitral valve stenosis can lead to serious heart complications if not treated.
  • Mitral valve regurgitation, or backward flow of blood through the valve, occurs when the leaflets of the mitral valve don’t close tightly, allowing a portion of the blood to leak back into the heart’s left atrium rather than flowing forward. This is often caused by mitral valve prolapse. Mitral valve prolapse occurs when the leaflets of the mitral valve bulge (prolapse) into the heart's left atrium during the heart's contraction. When this occurs the leaflets are unable to create a tight seal and there is backward leakage, or regurgitation, of blood into the left atrium.

Symptoms of Mitral Valve Disease

The symptoms of mitral valve disease vary depending on the type of disease: stenosis or regurgitation. Early in the disease process, patients experience minimal or no symptoms at all. However, when symptoms do occur, they may include:

  • Cough
  • Shortness of breath, especially when lying down or exercising
  • Fatigue
  • Lightheadedness
  • Pain or tightness in the chest
  • Irregular or fast heartbeat

Complications

Mitral valve disease can cause a variety of complications if left untreated. These include:

  • Heart arrhythmias in the upper heart chambers (atrial fibrillation)
  • High blood pressure that affects the blood vessels in the lungs (pulmonary hypertension)
  • Blood clots
  • Heart failure
  • Stroke
  • Enlarged heart
  • Death

Making the Diagnosis

The Frankel CVC team diagnoses mitral valve disease using the most advanced imaging and diagnostic procedures, including:

  • Echocardiogram: Ultrasound waves produce images of the heart’s structure and function.
  • Transesophageal echocardiogram: A scope passes down the patient's throat into the esophagus to provide a detailed view of the mitral valve from less than an inch away.
  • X-ray: This produces images of the heart on computer or film by sending X-ray particles through the body.
  • Cardiac catheterization: A long, thin tube inserted into the arm, upper thigh or neck is threaded up to the heart to provide an image of blood vessels to determine how well the heart is working.

Treating Mitral Valve Disease

Experts at the U-M Frankel Cardiovascular Center are involved in the latest clinical trials, which enable them to offer some of the most advanced treatment options for patients with mitral valve disease. Many of these options can’t be found at other health systems. Our experienced team will recommend the most appropriate treatment plan that will result in the best possible outcome for each patient.

Mitral valve repair is one of the few cardiac procedures where a patient’s life horizon returns to what it would have been naturally without a mitral valve condition. Performing these repairs early in the desease process before a patient's mitral valve disease progresses into advanced heart conditions such as congestive heart failure, atrial fibrillation, and pulmonary hypertension is our top priority.

Treatment options include:

  • Medication therapy
  • Open-heart surgery
  • Minimally invasive procedures, including minimally invasive surgical procedures and minimally invasive transcatheter procedures

Medication Therapy

Medications to control heart rate, atrial fibrillation and blood pressure are often used to treat heart valve disease. However, medication does not prevent the progression of mitral valve disease, but can help ease the symptoms.

The Frankel CVC team will determine the appropriate medication therapy for your symptoms. Medications may include:

  • Diuretics to reduce the accumulation of fluid in the lungs
  • Beta blockers to slow the heart rate
  • Blood thinners, such as aspirin or prescription drugs, for patients with heart arrhythmias

Open-Heart Surgery

Open-heart surgery is the traditional method of mitral valve repair and replacement. In open-heart surgery, a 6- to 8-inch incision is made down the center of the sternum (breastbone) to open the chest. The patient’s heart is then stopped and connected to a heart-lung machine for the duration of the surgery.

Whenever possible, and fortunately for the majority of patients, the experts at the Frankel CVC are able to repair the mitral valve, thereby keeping the patient’s natural valve in place and functioning normally.  If a patient’s mitral valve is severely damaged to the extent that a successful repair is not possible, surgery to replace it is the likely treatment. The valve is replaced with either a bioprosthetic (tissue) valve or mechanical valve. The type of valve selected is based on such factors as age, lifestyle and ability to tolerate blood thinners.

Minimally Invasive Mitral Valve Repair Procedures

Frankel CVC surgeons are uniquely qualified to determine who is a candidate for a minimally invasive procedure versus open-heart surgery. Our surgeons have expertise in less invasive mitral valve repair and replacement procedures. 

Surgical Procedures

Our team performs complex open surgical repair or replacement of the mitral valve using small incisions — approximately two to three inches — between the ribs on the patient's right side to gain access to the heart. This type of procedure has the potential to shorten a patient’s recovery time and hospital stay.

Transcatheter Procedures

Transcatheter valve technology represents a less invasive means for treating valve disease and is designed to allow physicians to deliver repair devices or replacement valves via a catheter through the body's cardiovascular system, thus eliminating the need to open the chest.

The team at the Frankel Cardiovascular Center is able to offer eligible patients the most advanced minimally invasive transcatheter options for mitral valve repair and replacement. A variety of innovative techniques and devices can be used to repair or replace the mitral valve without opening up the heart.

  • MitraClip is a device that offers minimally invasive treatment for mitral regurgitation in patients for whom open-heart surgery is not feasible. Using a transcatheter approach, the mitral valve is repaired percutaneously (through a needle puncture in the skin). A catheter is then guided through a vein to the heart.
  • Valvuloplasty may be used to treat stenosis, or narrowing, of the mitral valve. During valvuloplasty, a thin catheter (tube) with a balloon tip is used to stretch or open the mitral valve. The catheter is threaded to the heart from the blood vessels in the groin percutaneously with X-ray guidance.
  • NeoChord mitral valve repair system enables minimally invasive implantation of artificial chordae using a catheter-based approach to treat mitral regurgitation. Chordae are thin, cord-like tendons that connect the two mitral valve leaflets to the inside of the heart’s left ventricle. The chordae support the leaflets as they open and close to move the blood through the heart. When chordae become stretched or broken, the mitral valve isn’t able to close properly, resulting in leakage or regurgitation. The NeoChord repair system enables the chordae to be repaired using manmade fiber.
  • Transcatheter mitral valve replacement (MVR) has recently emerged as an exciting new frontier in the minimally invasive treatment of severe mitral regurgitation in patients at high risk for surgery. The procedure, now in clinical trials, involves replacing the mitral valve via a catheter threaded through a blood vessel. U-M is one of only a few health systems nationwide selected to participate in this clinical trial. Transcatheter technology is also being used to restore the function of failing bioprosthetic mitral valves. Known as a valve-in-valve procedure, a new valve is inserted inside of a failing bioprosthetic valve. This technique may offer the best valve replacement option for high-risk surgical patients. 

Patient Resources

Make an Appointment

To make an appointment to discuss your need for treatment, contact us toll-free at 888-287-1082 or email us at CVCCallCtr@med.umich.edu.