Heart valve defect series: Treatment options for a leaky or narrowed mitral valve
Our heart is the central organ that beats continuously from birth until death and pumps blood into our body. It supplies all organs and itself with vital oxygen and nutrients. But what to do when it is sick? Heart valve defects such as mitral regurgitation or stenosis are among the heart diseases that are treated relatively frequently. The therapy does not have to involve major surgery.
Many people think that cardiovascular diseases only play a role in old age. However, younger people can also be affected, especially if there is a family history of the disease. The problem with heart valve defects is that they can go unnoticed for many years, as those affected often experience no or hardly any symptoms or do not think of heart valve disease when they experience symptoms such as shortness of breath, reduced physical performance or chest pain. This can make early diagnosis considerably more difficult. Doctors therefore recommend regular check-ups from the age of 35. A so-called cardio check-up is usually carried out by a cardiologist in consultation with the family doctor's practice.
Heart valves in need of treatment
The most common heart valve defects include mitral regurgitation and mitral valve stenosis. In both diseases, the function of the left heart valve (mitral valve) is impaired, which is either leaky (insufficiency) or narrowed (stenosis). In both cases, less blood is pumped into the body via the left side of the heart, resulting in a reduced supply to the organs. Instead, the blood builds up in the left atrium and partially pushes back to the lungs.
As both clinical pictures differ in terms of causes, symptoms and progression, the treatment options also differ. Which treatment is the right one and leads to the greatest possible treatment success depends on the previous course of the disease and other factors. For example, age, other pre-existing conditions and lifestyle play an important role. Doctors from various specialties advise and decide on possible forms of treatment with those affected as part of an interdisciplinary "heart team". This heart team includes specialists from the fields of cardiology and heart surgery, as well as intensive care and general medicine. This ensures comprehensive care.
Treatment options for a diseased mitral valve
If mitral regurgitation is present, it is important to determine the respective form of the insufficiency and its severity in terms of the choice of therapy. Depending on the cause and type of pathological changes, doctors differentiate between the primary (degenerative) and secondary (functional) form of mitral regurgitation.
Drug therapy
People with chronic primary mitral regurgitation who show few or no symptoms and in whom the pumping function of the heart is not yet noticeably impaired are usually only observed initially. However, if the condition worsens, surgery is usually recommended due to the low chances of success of drug treatment.
Secondary mitral regurgitation is usually treated with medication at the beginning. The reason for this is that there are often other serious illnesses such as coronary heart disease or enormous weakness of the left heart and these people are at much greater risk of surgery. The initial aim is to eliminate the underlying cause of mitral regurgitation and treat the initial symptoms. Antihypertensive and vasodilator drugs such as ACE inhibitors, AT1 blockers, beta-blockers and diuretics (including aldosterone blockers) are used for this purpose. Depending on the severity of the disease, such early treatment with medication can already lead to a full recovery. If this is not the case, surgical or catheter-based intervention is also recommended for secondary mitral regurgitation.
Mitral valve stenosis cannot currently be treated directly with medication. However, as with mitral regurgitation, medication is generally used to alleviate the symptoms. In addition to beta-blockers and diuretics, active substances such as digoxin (a drug to control the heart rate) and blood-thinning agents (anticoagulants) can also be considered. The latter are particularly recommended if there is an increased risk of blood vessels becoming blocked by clots (embolisms), for example.
Open surgery or catheter procedure?
Acute mitral regurgitation occurs comparatively rarely, but is always severe with severe symptoms and is therefore always treated surgically as an emergency.
If chronic mitral valve disease worsens over time, a surgical or interventional procedure is usually performed. The diseased heart valve can be replaced with a prosthesis or restored or repaired (reconstruction). Reconstruction is carried out either by open surgery or by the less invasive catheter procedure. Which method can be used depends on many different factors, which are comprehensively clarified by the heart team before each procedure. Echocardiography as the main examination method is used in particular to determine the severity of the disease and the potential success of treatment.
In many cases where treatment is expected to be successful, i.e. the prognosis is good, the diseased mitral valve is repaired using a surgical procedure that is as minimally invasive as possible. This means, for example, that tissue from the pericardium in which the heart is located is used to build up the diseased heart valve. Such operations can be performed with the aid of an endoscope, which means that it is not necessary to open the chest. A small incision in the lateral chest wall is sufficient.
Another minimally invasive catheter-supported treatment method is the so-called MitraClip™ procedure. The mitral valve clip, which is inserted into the left heart valve, is located at the tip of a catheter that is guided through the large leg vein from the groin to the right atrium. From there, the catheter is pushed through the cardiac septum into the left atrium, where the clip is inserted into the left heart valve. This mitral clip supports the function of the diseased heart valve so that it can close better again. The heart valve is not replaced during this procedure.
The balloon catheter procedure, also known as mitral valve valvuloplasty or percutaneous mitral commissurotomy, can be used to treat mitral valve stenosis. In this procedure, the stiffened leaflets of the mitral valve are stretched with the help of a balloon so that blood can flow better into the left ventricle again.
A new heart valve
In cases where it is not possible to repair the existing diseased heart valve, it may be possible to insert a new valve. On the one hand, there are mechanical valve prostheses made of metal and plastic, which are mainly used in younger people. On the other hand, there are biological prostheses made from bovine and porcine heart tissue. In rare cases, human heart valves can also be used as donor organs.
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