By Mustafa Ahmed MD and David McGiffin MD
What is Mitral Valve Repair Surgery?
When the mitral valve is severely diseased it can lead to heart failure and associated symptoms such as shortness of breath and fatigue as well as heart enlargement. The most common diseases are a leaky mitral valve known as mitral regurgitation and a tight mitral valve known as mitral stenosis. Mitral valve repair is typically reserved for mitral valve regurgitation. When fixing the mitral valve by surgery there are 2 main approaches. The first is replacing the valve in a mitral valve replacement operation, for example using a metal or a tissue valve.
At myheart.net we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD
The second is repairing the mitral valve in a mitral valve repair operation. This is very important as very often valves that can be repaired are simply replaced; this is despite a number of well-known advantages to mitral valve repair over replacement. The reason this is done is because many surgeons simply aren’t experienced enough in the art of mitral valve repair.
What Happens in Mitral Valve Repair Surgery?
In mitral valve repair surgery, patients are taken to the operating room and put to sleep in the way they usually are for open-heart surgery. Then depending on the approach used the appropriate incisions are made. This can range from a full sternotomy where the chest is cut-open down the middle, or a smaller incision called a mini incision. Another method is robotic mitral valve surgery. Robotic mitral valve surgery does not require large incisions. Robotic mitral valve surgery is described in detail below.
The patient is then placed on a heart lung machine. This is important as it takes over the work of oxygenating the blood and delivering it to the rest of the body. It allows us to stop the heart and work on the mitral valve. The valve is then repaired using a number of techniques. Mitral valve repair surgery is very much an art form and experience is key. Techniques include putting in chords in place of the ruptured chords that led to the leaky valve in the first place. Cutting out extra mitral valve leaflet tissues for large prolapsed valves and making other modifications to the valve leaflets to prevent further leakiness. Finally a band is typically placed around the valve known as an annuloplasty ring. This is due to most patients with mitral valve disease having a larger than normal annulus.
Once the valve is repaired, the valve is tested to ensure the leakiness has resolved. Occasionally further modifications will need to be made. The heart is then restarted, the patient is taken of the heart lung machine and the chest is closed. The whole process may typically take between 2-4 hours depending on how complex the mitral valve repair surgery is.
Can all Mitral Valves be Repaired?
The simple answer is no, however its important to remember that in the right hands, the majority of valves can be repaired. The things that may prevent a valve from being repaired include, too large a heart, a very degenerated and calcified valve and a rheumatic heart valve. There may be a lot of mitral annular calcification making it difficult. Experts can repair even some of those. Importantly some experts may say that a replacement is preferable because although the valve can be repaired in the short term, the likelihood of recurrence is so high that a replacement makes more sense. A surgeon with a proven track record of repair and appropriate experience should only make that decision.
What’s the Difference Between Mitral Valve Repair and Mitral Valve Replacement Surgery?
In mitral valve repair surgery the patient keeps their own valve and a number of techniques as described above are used to repair the valve so it functions normally again. In mitral valve replacement surgery, the patient’s valve is essentially cut out and a new valve put in. This may be a tissue or a mechanical valve. Mitral valve replacement surgery is described in detail in this linked article.
Can Mitral Valves be Repaired Without Surgery?
Advances in technology have meant that there are ways in which the mitral valve can be repaired without having to undergo open-heart surgery. The most well known example of this is the Mitraclip procedure. The Mitraclip procedure is described in detail in this linked article. Currently the Mitraclip is reserved for patients that are considered too high risk for traditional mitral valve repair surgery. When I perform these procedures, a heart team that includes interventional cardiologists, cardiac surgeons, and imaging specialists to decide the best possible option for the patient assesses patients.
What is Robotic Mitral Valve Repair?
Robotic mitral valve repair surgery is an exciting option that involves the use of the Da-Vinci robot. This allows the mitral valve to be repaired through the use of very small incisions on the chest wall and avoids the need for a sternotomy. This option is not available in many centers and is highly dependent on the experience of the surgeon performing it. In the right hands it is a good option that allows a quicker recovery time than conventional open-heart surgery.
How long does a Mitral Valve Repair Last?
This depends on the operation performed and the condition of the valve and the heart at the outset. In general, if performed in an experienced center the probability of needing another operation in 15yrs is about 10%. In general mitral valve repair should be considered a long-term solution.
What are Restrictions after Mitral Valve Repair?
Patients are placed on a blood thinner called Coumadin for 4 weeks after the repair. If a full sternotomy is performed where the chest is cut open down the middle then there should be no heavy lifting for 8 weeks. Driving can usually be resumed after 2-3 weeks. Heavy lifting work can be resumed after 10 weeks. Office work can be resumed typically when the patient feels like it. At first half days rather than full days may be preferred. Recovery time is likely much quicker after robotic surgery. With the Mitraclip procedure patients may even be able to go home the next day.
Important Considerations for Mitral Valve Repair Surgery
As a structural heart and valve specialist I cannot emphasize enough the importance of going to a very experienced center when mitral valve surgery is being considered. This is for a number of reasons.
- Mitral valve repair surgery is one of the most experience dependent heart surgeries and many surgeons will simply replace a valve because they cannot repair it. This problem is avoided in expert hands.
- The chance of surviving is significantly better when the mitral valve repair surgery is performed in a reference center that is performing a high number of surgeries. In a non-complicated repair the chance of survival should exceed 99%!
- The chance of having complications around the time of mitral valve repair surgery is significantly higher in centers with a lower yearly number of surgeries. Complications include lung and kidney issues.
- In reference centers the options available ensure the right fit for a patient. In many centers mitral valve replacement surgery is the only option. In our center for example options include, standard mitral valve repair, mini approach repair, robotic surgery, redo and redo-redo surgery, and the minimally invasive Mitraclip procedure.
After Mitral valve repair in November 2015, should I be worried about getting a Lumbar MRI for a Ruptured lower disc? It seems to me that after open heart surgery, I should not have a small black wire across my abdomen, subcutaneously. I do not know if it was the drugs but it seems I pulled out at least an inch on each side. Dr. G. Lowrie performed it at Houston Methodist… I am worried about the MRI. Scared stiff. Thank you greatly!
If it was a mitral valve repair, from a technical viewpoint a MRI scan should pose no issue or concern.
Its been 7 years sense surgery. I have a ring around my heart vavle. I lifted a box that weighed at least 60 pounds or more. Because it was frozen fish. Can that ring comes off due to straining and heavy lifting. I’ve tossed and turned night. Worrying about this please comment back
The ring shouldn’t be affected by activity.
you can follow our twitter at @MustafaAhmedMD
good stuff
the information was very educating and reassuring
thanks
keep up the good work.
Hello there, I had Da Vinci (minimally invasive) mitral valve repair June 17th, 2016 at Cedars. I also have a ring. My heart was otherwise healthy and I exercised regularly before the surgery (hiking, karate, running, swimming, etc.) I’m in cardiac rehab and it’s a conservative program. I currently do an hour of low-medium intensity exercise a day (40 bpm above resting).
But I was invited to Magic Mountain and I wonder what your thoughts are about thrill rides (nothing too jerky, but a few loops and fast-but-smooth drops) 10 weeks post op. There will be walking to each ride then standing in line but I can leave when I get tired – the issue I’m worried about is the “thrill” part when I go on the ride and it’s effect on my healing heart. I go every year and I hate to miss it. Thank you for any insights!
Hi Melinda, the answer to that question differs on a case by case basis, it all depends on the specifics of the case. I would run that question by the office of the operating surgeon. From a heart point of view its fine. It all comes down to the wound and the healing of the musculoskeletal aspects.
I know a family who’s child is 9 and just recently found out their daughter will most likely need surgery to fix her mitral valve regurgitation. Can you recommend a great doctor in the Atlanta Georgia area? We live in a very small town a couple hours from Atlanta so there is no one I would considered qualified here.
What is the reason for operation, do you have any information regarding the valve abnormality?
I am a 61 year-old male who had mitral valve repair by mini sternotomy about 4 weeks ago. I went into A-fibrillation after surgery and had to be shocked, I was also put on Amiodarone. Prior surgery, I was in overall good health. My only symptom was feeling that I tired more easily. My blood pressure before surgery was 105/60 and pulse 55. These were normal reading for me. When I left the hospital my bp was 90/55 and pulse 85. I had little appetite. I was taken off Amioderone about 10 days after surgery. I have been exercising for 20-30 minutes three times a day and have very little pain. Right now, I feel I’m at about 40% of my per-surgery self. My appetite is still not good and foods I normally love don’t taste good to me. I’ve lost eight pounds. Also, I feel light-headed several times a day. My surgery was done at a well known cardiac center. I will being cardiac rehab in a couple of weeks. I take my blood pressure several times a day with reading from 88/55 to 110/60. Pulse is now around 75. I have an appointment with my cardiologist in a few days. Maybe I’m impatient, buy I thought I would recover more quickly due to my good condition before surgery.
Its amazing what surgery can take out of someone relatively healthy, although usually the post operative course is smoother than described. We utilize a predominantly robotic approach in order to further accelerate recovery where possible.
Initially, I was told that I may be a candidate for Right Mini-Thoracotomy or the Robotic approach. Upon testing close to surgery date, it was changed to Mini-Sternotomy due to the location of the damaged leaflets. I wonder what percentage of cases actually end up having the robotic approach??
Rob
Location of the leaflets typically had nothing to do with the approach. In our program, very few robotics are converted to thoracotomy and those are generally identified as such before hand. The key to robotic heart surgery is to go to a very experienced program.
Did you suffer any side effects from the amiodarone
I was told by the echo tech at Plano heart hospital my “score” was 0.9. He said this was on the cusp of moderate to severe (1.0). There was a lot of red. The Drs. Recommended repair. I have limited symptoms. Does this sound reasonable?
Do you have a little more information? The scores you mention are not used to grade the severity of MR.
Hello,
I was recently diagnosed with moderate mitral valve prolapse regurgitation but still in the testing stages and I have a sister that had open heart for mitral valve on September 23, 2016 along with an ablation for a-fib and a brother that is also getting tests to determine if surgery is needed as he also has mitral valve. I live in Hartford, Ct can you recommend a hospital nearby that specializes in this surgery successfully? Is it normal to have an a-fib episode after the ablation? Thank you!
It depends on whether a minimally invasive approach is warranted. I would recommend asking very frankly, mitral valve repair success rate (not replacement!) and number of surgeries performed. Also ask for outcomes of cardiac surgery and volume of surgery at any given institution. A fib can certainly recur after an ablation depending on the severity of the afib initially.
Hi Deborah, I read with interest your question – I am having a mitral valve repair in 6 weeks, my sister had her mitral valve replaced in Oct 2017, she had been monitored for years , and then contracted endocarditis which necessitated the replacement. My brother is also meeting with his surgeon next week to discuss his mitral valve replacement. I hope all you are all doing well. Did the doctors say if it was a congenital condition?
I have a 19month old baby girl that had her initial OHS at 1.5 months to repair AV canal, mitral valve stenosis, ticuspid valve repair. We are now to the point of needing a second surgery due to Severe mitral valve stenosis, with mild to moderate regurgitation. Plan A is to repair the valve and then Plan be is a tissue within a stent replacement. I believe the latter is a newer method and wondering if this is better than without a stent?
Do you have more specifics of the case, its complex and id need a good deal more information regarding it. What was the exact surgery initially done?
Dr. Ahmed,
My husband just went through a mitral valve repair 2 weeks ago. My question is that he had been running a fever between 99–100.9. I was told to monitor and if it reaches 101 to call or take him to the emergency room. Why is he running a fever? How concerned should we be? Is there anything that he can take to bring down the fever? He does take aspirin 81mg daily.
There are many reasons for this however he needs to be worked up to ensure the cause is not concerning. I would suggest seeing the associated cardiologist or cardiac surgeon to ensure nothing is missed.
Hi there. My mom is currently undergoing treatment for MR. She had open heart surgery 12 days ago in the NYC area with a team of very experienced cardiac doctors. She had both her mitral valve and cuspid (sp?) valves repaired with a full sternotomy. Yesterday, we were informed that they will need to go back in because of an issue with the leaflet that is causing adema. She has not left the hospital yet and they have done a TTE procedure. Two days post-op, she did code, and a temporary pacemaker was installed, and she went into afib a week post op during physical therapy. How often does something like this happen? She has had a rough recovery at this point, but was otherwise a healthy 57 year old woman and I am extremely worried about the next steps.
Sorry to hear that. Do you have any specific details of what the problem is felt to be? What did the repeat TEE show?
Hi there, I am a 72 yr. old male diagnosed in the early stage of Pulmonary Fibrosis. In addition, I was informed from a recent Echo that I had severe mitral valve regurgitation . Would my lung problem prevent me from having repair or valve replacement surgery?
It all depends on the extent of your fibrosis. If the lung disease is felt to make you too high risk for surgery and your valve is suitable transcatheter mitral valve repair may be an option such as the mitraclip procedure https://myheart.net/articles/mitraclip-procedure/
Dr. Ahmed, Thank you for your time in providing the information on your website. Very informative.
My 79 yr old father has been diagnosed with MR and we will meet with his surgeon next week after prelim tests, to discuss results and surgical options.
I would like to ask if you can provide guidelines on the following:
– can you define what would be a good surgeons “proven track record of repair” and “appropriate experience”
– what defines “a very experienced center”
– what would be considered “a high number of surgeries”
– define a MV REPAIR success rate
My father is being treated by the Presbyterian Health System in Albuquerque, New Mexico. I am researching and we may seek a second opinion. I live in Texas.
Thank you again for your time and input on possible guidelines.
We all have different standards for center of excellence, as the director of a very busy center of excellence i will answer your questions not based on evidence but on my experience. I am not personally familiar with your system so cant comment specifically on that.
– can you define what would be a good surgeons “proven track record of repair” and “appropriate experience”
In my opinion, during your consultation the mechanism of MR needs to be clarified. If it is degenerative disease then an almost 99% repair rate needs to be offered. If not straightly degenerative then the odds of repair and the underlying mechanisms need to be discussed at length. Bottom line being you need confidence that a degenerative valve that can be repaired will be repaired, its terrible how many people that should get repair get a replacement, the exception in my opinion being functional/secondary/ischemic MR whereby repair can be counteractive and at times a replacement makes more sense long term. Experience is variable, but key, particularly in robotic surgery which although often an excellent option totally is experience dependent.
– what defines “a very experienced center”
In our center we have experience of many hundred per year with all modalities combined, i would hesitate to go to a center where less than 50 repairs per year are being performed.
– what would be considered “a high number of surgeries”
Once again depends, sometimes a better surgeon is at a lower volume place, although i would be hesitant to undergo surgery at a place where there are less than 300-500 cumulative cardiac surgeries performed per year.
– define a MV REPAIR success rate
A valve that can be repaired should be repaired, its on a case by case basis and cant be answered in a blanket fashion, for pure myxomatous disease the repair rate should be 100%.
Dr Ahmed,
Thank-you for an informative article. Is there a center that you can recommend that has a good track record for repair in central Florida?
Thanks Jim
Im not sure about Florida, we have a lot of patients that come from Florida, although I’m not sure if central.
Hi, I have found this website to be very informative, my husband has mitral valve prolapse with regurgitation a swollen aorta and atrial fibrillation. He goes to see the surgeon this Tuesday to see if surgery is possible at this time. My question is can you have surgeon on a mitral valve prolapse with regurgitation when there are other problem’s that also have a timing. My concern is what are the risk factors if any?
Do you mean a swollen atrium or a swollen aorta? In patients with Afib, a MAZE procedure can be done at the same time to treat the atrial fibrillation, in fact its fairly standard at our center.
Hi, I mean a swollen aorta as well as what I have already mentioned. Just wondered if there are any risk to having surgery for both at the same time with each having a timing period?
I was diagnosed with mild to moderate mitral valve regurg. I am 30 yrs old. I have many symptoms and pass out. Should I repair the valve before it gets worse. I want to avoid open heart surgery later in life.
The mild to moderate mitral regurgitation, if indeed mild to moderate, is not a cause for concern and not related to your symptoms. You don’t need surgery for it.
I was told that’s what it was from. I have very cold hands and my pulse is very high most the day. At what point do I start considering repair?
Dr. Ahmed,
My 57 year old mom was recently diagnosed with severe mitral valve regurgitation due to an unrealized valve defect since birth. She had mitral valve repair surgery 4 weeks ago, with the full sternotomy. Prior to surgery, she had breathing problems/shortness of breath symptoms. For the first three weeks after the surgery, her breathing was very good, she was recovering well and doing great. Then last week, she all of a sudden starting have shortness of breath and extreme lightheadedness. Xrays show no fluid in the lungs, bloodwork all came back normal and EKG shows mild regurgitation, nothing to explain her symptoms, which are now much worse than they were prior to surgery. She can literally barely walk across a room without being short of breath. The doctors don’t seem to have answers and told her all the test results came back fine. It is very frustrating. Do you have any ideas we could look into? I appreciate any guidance you can give us.
Sorry she’s having such a tough time post operatively. Im assuming an echo has been done and is ok? Its only been a few weeks and if everything checks out ok (blog work, cxr, echo etc) then it may be that she just needs a little while longer to bounce back after a sternotomy approach.
Not sure how old this discussion is but I recently have been in the hospital for sob chest pain and my ck levels were 2282 but other levEl did not indicate a heart attack my questions are, did that contribute to my now diagnosis of moderate to severe mitral valve regurgitation with class 1? I have been reading up on this mitral valve repair surgery and want to have it repaired before it’s worse is that an option? Also I have a 9x6mm lung nodule can they remove at the same time to save me from 2 procedures? I am otherwise healthy am 53 yr old what direction should I go? I am extremely tired all the time and sob I thought I should have repair done before it gets worse. Thanks
Do you have further details of your echo report?
Actually I have just had a tee and heart catherization done on 4/20/17 and that showed severe prolapse of p2 and severe regurgitation with very eccenteic jets I am told now I do need mitral valve repair and was wondering which way I should have it done. I want a lasting valve repair and do not care about a scar …is it best to go with the traditional open heart for the best possible repair? I am otherwise healthy aside from this issue so I believe I would do well with the traditional way…makes me nervous having more invasive ways just for smaller scars
Its all about the surgeon and not the operation. In our center we almost exclusively perform robotic repair, the main reason being we get the repairs we desire, a minimal approach and a faster recovery. We feel that our expertise allows a better repair through the robot than open. In other centers where minimally invasive expertise is not available then an open approach may be favored. It all depends on local expertise and outcomes. I am strongly in favor of mitral valve repair being performed only at a handful of high volume centers in the United States rather than the free for all it has become. Go with the place that is a reference mitral center with experience, outcomes and obsession with repair.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I had a minimal invasive mitral valve repair on June 7,2016. It turned into open heart surgery as there was some bleeding that couldn’t be stopped without cutting my chest open. Instead of a 2 1/2 hour procedure, it took an additional 4 hours to complete. When I came to, I couldn’t lift my right leg off the bed and could barely walk. From the incision at my groin to my ankle remains tingling. My right knee is tender and bunched up and my right quad muscle is still very weak. When tapping my right knee for a reflex test, nothing happens. I went through 6 months of physical therapy and regained movement in my right leg, but nothing else has changed. I was told that I was a one in a million case. I hang wallpaper and paint for a living and needless to say, getting up and down a ladder is difficult, along with stairs. I can’t run anymore,let alone jog and I am considering a lawsuit at this time, because I don’t think my situation is going to improve anytime soon, if ever.
I had a similar situation after right heart catheterization when I was 25. My leg went numb to the ankle, first thing was to rule out a blood clot. A nerve was damaged during the procedure. It took, if I remember correctly, 4-5 years to recover completely. But, everything is normal now. It happens, doctors are human, he in turn saved my life. There was no mistreatment or intentional harming.
Well that is somewhat comforting, I’ll be retiring by then. I hang wallpaper and paint for a living and getting on a ladder is difficult at best, let alone getting on my knees and getting back up. Yea I know that doctors are human,my sister is a cardiologist. My surgeon did a great job, it’s just the fact that my motor is fixed and my transmission doesn’t work properly anymore. I waited for 11 months before finding out if I had a case because it was just an unfortunate result of the surgery. I did me want to sue, but I did lose a lot of income, etc. I just hope it all goes away and my quad muscle comes back soon.
I’m a 46 yo old otherwise healthy male, diagnosed with a severly leaky Mitra valve, I’ve had chest ultrasound, esophagus tee test and am scheduled for a cardio caterization, my Dr has expressed open heart surgery as my best option, I inquired if minimally invasive or da Vinci robotic would be options he stated open heart is the best option given my age and health? Any reasons you might attribute? Thank you
In our center we generally perform our mitral surgery through a robotic approach. In cases where we don’t use the robot for pre determined reasons, we prefer a minimally invasive approach. If there are coronary artery bypasses to be done, then we perform a sternotomy approach or a hybrid approach with stenting / robot if the patient prefers. We find that a minimally invasive approach, if performed in expert hands leads to faster recovery.
I had mitral valve Repair 8 weeks ago my appetite is good I healed fast. My heart us in great shape no blockage arteries clear , started being more active a week ago having pain middle of chest where I was cut is this normal.no shortness of breath or anything I’m 59
With increased activity some pain may be noticed, although if worsening or concerning in nature i would recommend a brief medical check up to provide reassurance.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hi i just had an echo and it shows i have moderate to moderately severe mitral regurgatation its changed in one year my EF is 74% iam so scared i have no symptoms.what do you think?
Dr dos not seemed concerned iam 59 years old female. I do get alot of pvcs dr said they are benign.
Hi Debbie,
See if the following article answers your questions. https://myheart.net/articles/mitral-regurgitation/ I think you will find it helpful.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hello,
I was experiencing PVCs that were determined to be the cause of fatigue, lack of energy, etc. After trying several drugs to no avail, the physician recommended ablation. The procedure took over four hours and was almost canceled as the offending section was not found. Ultimately the PVCs were simulated, and the blame was placed on scar tissue left from a mitral repair I underwent in 2003 at 44 years old. I can’t find any information on the possibility of scarring causing the PVCs. A second opinion on the possibility from a knowledgeable physician would be most welcome. I’m one day beyond the procedure, so the full positive affect hasn’t hit me yet, but my heart rate is full on. Much better. Thank you for your time.
Mechanisms of PVC can be fairly complex and often characteristics at the time of ablation may lead to identifications of mechanism which may lead to the conclusion that it is scar related. Was any testing such as MRI scanning done prior? Also if there was coronary disease also, ischemia related scar is a possibility. PVC’s that persist after isolated mitral valve repair are not at all common after the immediate postoperative period.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
I’ve read many studies that PVC’s are common after Heart Surgery
My husband had minimally invasive mitral valve repair 3 years ago. He was put on asa 81mg daily. He recently had slow bleeding ulcer which was cauterized and clipped after receiving 8U of RBCs. My question is does he still need to take ASA daily? GI Dr. said bleed was probably caused by ASA and my husband stopping his omeperazole med. He has recuperated well from the bleed Hgb 12.6. He also is now Taking protonix 40mg.
I cant directly prescribe medical treatment on here.
I would recommend you speak with the repairing surgeon or the referring cardiologist to ask if there is an indication for aspirin other than the heart valve.
In terms of the valve itself repair is usually accompanied by ring placement around the valve that serves to reinforce the repair. The cloth material around the ring is thought to take a year to endothelialize and therefore many people advise aspirin for a year. 3 years out is not common. He has GI issues and if there is no other need for aspirin it would not generally be recommended as the risk to benefit ratio may favor stopping it.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
This is a great site.
My father in law is scheduled for MV repair at a reputable NYC hospital. He is 65 years old has a p2 flail leaflet and minimal symptoms. The plan is right thoracotomy. I understand general risks regarding mortality, stroke and endocarditis. Other than risk of a fib peri/post-surgery, what other questions should i ask? Lastly, what typical medications are patients on post MVR? BB? How is decision made for Coumadin vs DAPT and what is data? Thank you very much.
I suggest you have the visit first then if you have any questions feel free to post here.
In terms of the post repair therapy, amazingly there is no clear answer to this and studies that are definitive are lacking. Some advocate a few months of Coumadin whereas others aspirin. In those with peri-operative or chronic arrhythmia atrial fibrillation it is clear that anticoagulation with coumadin (sometimes noac) is needed. In those at high bleeding risk it is avoided. This decision in general differs on a center to center basis.
I’ve had two mitral valve replacement surgeries. Both have been replaced with pigs valves. I’ve noticed I’m very out of breath just walking up my stairs. Is that normal?
No thats not normal. Have you been worked up for this? Cardiac issues need to be ruled out, then if needed further assessments to see if a cause can be identified and your quality of life improved. Mention to your Dr that your symptoms are significantly impairing your quality of life.
you can follow my twitter at @MustafaAhmedMD
Dr my mother is 88 years old and had a stroke 8 months ago and has had a fib in the past now her Dr in Florida is stating that she should have the valve procedure. Will the prior a fib and stroke make her a poor candidate for the procedure and where would find a specialist list in the Ocala area.
At 88, surgery isn’t a good idea if it can at all be avoided no matter how well the patient is. I suggest the mitraclip option be explored, the team at Princeton Baptist Birmingham Structural Heart and Valve Center would be happy to advise you or point you in the right direction.
you can follow my twitter at @MustafaAhmedMD
I had a mitral valve replacement in Nov 2017. I am on warfarin for the rest my life why? I read where some people took it for a short time.
If its a mechanical valve then lifelong anticoagulation is required. If bioprosthetic then its not usually lifelong unless other factors exist that would warrant it such as atrial fibrillation or a history of clotting disorders.
you can follow my twitter at @MustafaAhmedMD
I’m a 39 year old male aviator in the military and had a mitral valve repair about a 18 months ago due sever leakage caused by torn chordae and flailing of the P3 leaflet. I was an average male running 3 times a week and active. Post recovery I noticed my running stamina had not returned after a year despite working out 5 times a week. I was barely able to run 1.5 miles in 15 minutes vs 12 min prior. This promoted me to ask for a TEE to determine if something was wrong. The test reviled moderate reg from the P1 leaflet area. The surgeon wants to replace it with a mechanical valve which means the end of my career. He’s against a redo repair stating the valve tissue is probably soft. My concern is the TEE reviled the repair on the P3 leaflet was successful so why would the P1 have the same outcome. What are the success rates for repair re-do surgeries and have you any advice? I’m in Omaha NE and do know were to go to find a specialist. Especially one the military will let me go to. I don’t know what to do.
In our center we would likely try and repair the valve. I think you should seek an opinion from a dedicated mitral valve reference surgeon.
you can follow our twitter at @MustafaAhmedMD
sir.
I m a pharmacist and 25 year-old
last year I have diagnosed mitral valve regurgitation with prolapse from echo report
now I have chest pain frequently and my EF 60% and cardiologist said better to undergo surgery
but wish to repair my Mitral valve instead replacement….is it possible…????
LV SIZE :NORMAL
LV EDD :56mm
LV ESD.:38 mm
chest xray: NORMAL
AV:NORMAL
LA:Not dialated
MITRAL VALVE PROLAPSE(bileaflets)
conclusion :- GRADE(¡¡-¡¡¡ )MR
Yes, it absolutely should be repaired and not replaced in prolapse.
you can follow our twitter at @MustafaAhmedMD
Where is Princeton Baptist hospital located?
In Birmingham, Alabama
HI
I am a very healthy 60 year old female that recently (may 30th) had urgent mitral valve repair and left atrial appendage ligation. The surgeon was SUPER…she did an amazing job. Due to summer schedules I am not going to see her until 6 weeks after surgery.
My question is the sternum area is not painful but my right breast(left one is fine) is numb and hurts(yes at the same time??? in areas)…is this from all the trauma of surgery? Or possibly from the right sheet tube which was very uncomfortable. I have no fever and have lost all the fluid weight and then some.
I find myself hunching over to relieve the pain somewhat but then have to remind my self too sit up straight
Difficult to say, although its likely routine surgical related, i recommend at least calling the office and reporting the symptoms.
you can follow our twitter at @MustafaAhmedMD
I am a 64 y/o female with long standing persistent AFib. Standard procedures have been unsuccessful in treating it. Progressed to where I needed OHS on 8-29-16 for severe regurgitation of the mitral and triscusped valve. They performed 5 procedures: Repaired both valves, repaired hole in heart, Maze procedure and ligation of left atria. I was in the hospital for 12 days and on the 9th day had a Pacemaker put in with 2 leads and I am 100% paced. I have remained symptomatic with SOB, extreme fatigue, light headed, dyspnea despite my efforts in cardiac rehab and med changes for symptoms. My symptoms have worsen and I have gone through several tests. The most recent, a cardiac catheterization. My cardiologist said the test is conclusive that the repair done on my mitral valve is not working. The ring is obstructing the flow and the valve is leaking again. My cardiologist and surgeon are saying I need a replacement. I am physically in a different place than 2 years ago when I had my first OHS and on different meds, such as Warfarin, Nadolol, still on ASA, Lasix and Diltiazem, so concerned about the risks. I live in CT and my insurance will only cover in state. What reference center and Dr would you recommend for a 2nd opinion. Is another OHS necessary over a less invasive one, and do you think a redo as opposed to a replacement would be possible? The catherization showed pressure in the bottom chamber was fine, but pressure in upper chamber “went through the roof” with exertion. They have also mentioned a “stiff heart”. If you could direct me to the best hospital in CT, I would greatly appreciate it. Thank you.
Patricia
Im sorry but i’m not really aware of centers in CT. The place you go absolutely must be a reference mitral valve center.
you can follow our twitter at @MustafaAhmedMD
What are your thoughts on my diagnosis? Is it common for a mitral valve repair not to work and why?
What are the specifics?
Hello.i had a mitral valve repair in April 2016. I am more or less ok but find my heart beats go high with cold. How high can it go with no issues? I am hoping to go skiing but am a little nervous. I am a 66 year old woman. Would appreciate some advice as I don’t want to inadvertently cause a problem. Thank you
I am a 75 year old woman diagnosed with bileaflet mitral valve prolapse. If I decline surgery, what are the consequences? I know my life will be shortened, but could I maintain a decent quality of life with physician’s help?
This depends on the presence of symptoms, the severity of the regurgitation, the shape of the heart and the strength of the heart. Those details would be required to comment further.
Dear Dr Ahmad
Thanks in advance for your time!
I am a 47 year old healthy female diagnosed with Mitral valve regurgitation. I had surgery in October 2018 and then it’s been now 10 weeks. My echo now shows the regurgitation to be back at the moderate to severe level. They say we have to re operate . We don’t know what went wrong .
Any advice ? How safe would this re operation be ? The original repair was done through a minimally invasive approach.
That is very unfortunate, what is the mechanism of the regurgitation?
you can follow our twitter at @MustafaAhmedMD
are blood thinners required ( rest of my life) after mitral valve repair surgery. Like mechanical valve replacement, and the repair with the ring
For mechanical yes. For ring repair no.
you can follow our twitter at @MustafaAhmedMD
Hello Dr.Ahmed,
I’m 46 …and mother of 2. I currently have a moderate to severe mitral valve prolapse and will have to have surgery next year at some point. I want to move my surgey up in hopes of avoiding “severe medications” and having to receive open heart. Other than the prolapse, my heart is healthy. I’m totally terrified of open heart among with the deformity left behind by the scar. Where should i go here in the tristate area that specializes in minimally evasive valve repair procedures. I’m not sure why open heart is still done with faster recovery options available. Is this an insurance situation where facilities are paidmore depending on their elected process? I really do not want the open heart of I have real options. Please help.
Have you considered robotic. I would be happy to have you evaluated in our center.
Please follow our Twitter at @MustafaAhmedMD
Hi Dr. Ahmed,
Thank you for the great info on your website. I am asking about my 81 year old dad. He was diagnosed with severe mitral regurgitation. Partial P1 flail and P2 prolapse. He has no symptoms/healthy and current reco is open heart. He does have afib so takes 5mg of Eliquis. He is not candidate for mitraclip given that the torn tissue is in corner. Just wondering if you have had other patients in similar condition and what do they do.
I have in general not had a problem applying the mitraclip in the corner (commissural cases) this may come down to experience.
follow our twitter at @MustafaAhmedMD
Good evening. I had successful Robotic Mitral Valve surgery with a maze exactly 7 weeks ago by an outstanding surgeon. Prior to surgery I was in excellent physical condition and exercised dailey. My resting HR was in the high 50’s. My BP was typically around 120/70. I had absolutely no symptoms.
My BP now is running much lower around 103/66 – 99/66 – 105/67. My resting heart rate is running in the higher 60’s to low 70’s now. Sometimes when I go from sitting or bending over to standing I feel light headed. I also get winded walking up stairs. The only med I am on is Elliquis. I am walking 4-5 miles 7 days a week with no problem.
Is this normal or am I expecting too much too soon. I am concerned that my that my LV hasn’t responded well to the surgery. In theory I would think that I would be feeling much stronger since the severe regurgitation has been corrected? Would like to hear your thoughts and comments? Am hoping to get back to the physical lifestyle I enjoyed prior to surgery.
Have these symptoms since resolved?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello, I have been struggling to get a full breath since my mitral valve repair open-heart surgery in 2015 (in 1993 I had open-heart surgery for an atrial septal defect-quarter-sized hole in my heart). I assumed my quality of life would improve, and instead have felt worse. Details: I am a 47 yr old woman in very good health, non-smoker, with no asthma or other issues. Since 2015, I have had ultra sounds and a cardiac stress test in trying to determine the cause of my shortness of breath. My cardiologist could find nothing wrong, saying everything looked great (he is a well regarded cardiologist and my surgery was at a very good hospital-no concerns with quality). I notice difficulty breathing most when I lay down. I have to sit up and try to take a deep breath-it feels like a yawn and can take a few attempts-and only then do I get a sense of relief. But as soon as I lay down again, it starts over. At times I get light headed. It is impossible to sleep on my left side-I feel like I cannot breathe at all if I do. At times the shortness of breath is while I am at work, sitting or standing, etc. But it is most noticed at bedtime, which interferes with my ability to fall asleep. There have been a number of times when while I am laying down, it almost feels like my heart slows to a stop, which is very scary. At these times I try to breathe deep or cough to “kick start” my breathing. I am very frustrated, and a bit depressed, to be honest. I have seen a pulmonary doctor to rule out any lung issues-the doctor found nothing. The only thing I can think of is a few months following my surgery, my PCP prescribed 10 mg of adderall for my ADD. This did raise my normally very low blood pressure. My PCP suggested stopping the adderall for awhile to see if the symptoms go away, but it did not change anything. Any ideas?
Has diaphragmatic issues been ruled out?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dr. Ahmed,
When is it decided what type of procedure is to be done for someone newly diagnosed with mitral valve regurgitation?
During my annual wellness exam my primary doctor noted my heart murmur was louder than the previous year and ordered an echocardiogram.
I’m 70 years old and didn’t feel any symptoms. I’ve maybe become more tired here and there at times during the day and may take a brief nap or maybe get out of breath working out or hiking but felt it was to be expected at my age.
After the echo I met with a cardiologist who informed me that I will need my mitral valve repaired possibly with open-heart surgery. The heart cath has not been done.
Is it determined at the time of the heart cath what type of procedure I will need?
Thank you for your time
Do you have details of the echo report?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Doctor,
My Mom (59years) have undergone MVR surgery in 1991 and was working fine till she undergone Gallbladder and Cyst surgery in December 2020 (EF level at that time is 40%). After this surgery she is recovering fine, but all of sudden from past few days she get major complications,
Heart size in enlarged from past couple of year (EF Level is 60% during that time)
Chest Congestions is observed.
Non-Willingness to eat food (hardly 1 bowl of oats throughout the day with 1 cup milk)
Swelling in toes
Breathlessness, cant hold breath for 2 seconds.
Unable to sleep, uneasiness in breathing so cant lay down for long.
Weakness
Running Medication :- Warf-5/Lacix/Digoxin/Frucimide/Aton-25/Ecosprin75mg/
As is it COVID time, so we are bit afraid of visiting hospital as it seems immunity of my mom is very week at this time.
On consultation with doctor they said, heart size is increased and it is pushing pressure on lungs and facing difficulty in blood circulation which gives indication to mind that intestines are full and stomach doesnt need any food.
They suggested we may have to undergone heart transplant!!! is it the only option left or MVR replacement can also work fine ?
Please have your suggestion on this.
Regards,
kunal Meshram
Hello, I had MV & Tricuspid Valve repair done in 1993, age 36, at & by: THI/then St. Luke’s Episcopal Hospital,Cooley Group, Houston, TX. My pre-op cath ejection fraction; 37%, heart biopsy during same cath revealed cardiomyopathy. I experienced post op complications requiring pericardial window, 8 months later I had wires removed due to nickel allergy. Only piece of “equipment” I have is a dacron Cooley ring around Mitral chords. I’m now soon to be 65 & have accommodated for some time symptoms reminiscent prior to the procedure. I have cardiology checks, echo scheduled soon, yet they have been “good”,with normal echo EF,(I keep copies of all tests done.) I traveled to Dr. Cooley from Midwest in 93 as repair work was not being done here, I saw nothing but issues by consenting to replacement then. Now I guess I’m asking, I have done so well,considering, where is best as possible recommendation for a good work up? Not able to travel to TX. Thank you.