Mitral Valve Stenosis

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Mitral Valve Stenosis

Overview

Picture of the heart

What is mitral valve stenosis?

Mitral valve stenosis is a heart problem in which the mitral valve doesn't open as wide as it should. It is a lifelong disease.

When you first develop it, you most likely have no symptoms and notice no change in your health. Symptoms develop over 10 to 20 years or more. Mitral valve stenosis can lead to heart failure, a stroke, an infection in the heart (endocarditis), or a fast, slow, or uneven heartbeat (arrhythmia).

How does the mitral valve work?

Your heart has four chambers and four valves. The valves have flaps, or leaflets. The flaps open and close to keep blood flowing in the proper direction through your heart.

The mitral valve connects the heart's upper-left chamber (left atrium) to the lower-left chamber (left ventricle). When the heart pumps, blood forces the flaps open, and blood flows from the left atrium to the left ventricle. Between heartbeats, the flaps close tightly so that blood does not leak backward through the valve.

See a picture of the heart and its chambers, valves, and blood flow.

See a picture of an open and closed mitral valve.

With mitral valve stenosis, the mitral valve becomes stiff or scarred, or the valve flaps become partially joined together. The valve doesn't open as widely as it should. As a result, not as much blood can flow into the left ventricle. More blood stays in the left atrium, and blood may back up into the lungs.

See a picture of mitral valve stenosis.

What causes mitral valve stenosis?

Nearly all cases of mitral valve stenosis are caused by rheumatic fever. This fever results from an untreated strep infection, most often strep throat. But many people who have mitral valve stenosis don't realize they had rheumatic fever.

What are the symptoms?

Symptoms do not usually develop for 10 to 20 years after stenosis starts, and they may take as long as 40 years to develop. After you develop symptoms, they may not become severe for another 3 to 10 years.

When symptoms first appear, they usually are mild. You may only have a few symptoms, even if your mitral valve is very narrow. An early symptom is shortness of breath when you are active. This shortness of breath may seem normal to you.

Later in the disease, symptoms may include:

  • Shortness of breath even when you have not been very active or when you are resting.
  • Feeling very tired or weak.
  • Pounding of the heart (palpitations).

Call your doctor if your symptoms get worse or you have new symptoms.

How is mitral valve stenosis diagnosed?

Mitral valve stenosis may not be diagnosed until you've had the disease for some time. If you don't have symptoms, the first clue might be a heart murmur your doctor hears during a routine checkup.

Your doctor will ask you questions about your past health and do a physical exam. If your doctor thinks you might have the disease, he or she may do more tests, which may include:

  • An electrocardiogram (EKG or ECG). This test can check for problems with your heart rhythm.
  • An echocardiogram. This ultrasound test lets your doctor see a picture of your heart, including the mitral valve.
  • A chest X-ray. This shows your heart and lungs and can help your doctor find the cause of symptoms such as shortness of breath.

These tests also help your doctor find what caused the stenosis and how severe it is.

How is it treated?

Treatment depends on how severe the disease and your symptoms are.

  • You'll probably need only regular checkups if you have mild or no symptoms.
  • You may need medicines if your symptoms bother you or concern your doctor.
  • You may need your mitral valve repaired or replaced if you have severe symptoms, your valve is very narrow, or you are at risk for other problems, such as heart failure.

You will likely need regular echocardiograms so your doctor can check for any changes in your mitral valve and heart.

Talk to your doctor about your activity and exercise. If your stenosis is mild, you'll probably be able to do your usual activities, get mild exercise, and play some sports. But if your stenosis is moderate or severe, it's best to avoid intense activity or exercise. Your doctor can help you choose the right type of activity or exercise.

Talk to your doctor about how much sodium you can eat. Sodium causes your body to hold extra water. This can make shortness of breath, tiredness, and other symptoms worse.

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
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Cause

Virtually all cases of mitral valve stenosis are caused by rheumatic fever, which can follow an untreated strep throat infection. But many people who have mitral valve stenosis don't realize they had rheumatic fever.

In recent decades, cases of rheumatic fever have decreased considerably in Canada, the United States, and western Europe. But many people throughout the world still get rheumatic fever. This may include immigrants from regions where rheumatic fever is more common.

Other less common causes of mitral valve stenosis include:

  • A congenital (from birth) heart defect that causes mitral valve stenosis in infants and young children.
  • Infection of the mitral valve or the adjacent heart muscle (infective endocarditis).
  • Metabolic disorders, such as Fabry's disease or Hurler-Scheie syndrome.
  • Hardening of the mitral valve components (annulus and leaflets) due to aging.
  • Hardening of the mitral valve due to severe kidney disease.
  • Conditions that cause scarring of the mitral valve (lupus, rheumatoid arthritis, carcinoid syndrome).
  • A noncancerous tumor in the left atrium (myxoma), which can also block blood flow across the mitral valve.
  • The diet medicine fen-phen. Fen-phen was a popular diet drug that was taken off the U.S. market in 1997 because of its link to heart valve disease.

Symptoms

Although mitral valve stenosis is a lifelong disease, symptoms usually take 10 to 20 years to develop and can take as long as 40 years. Early symptoms are often mild and hard to distinguish from other forms of heart disease.

In the later stages of mitral valve stenosis, the left atrium may become damaged, causing more noticeable symptoms.

Symptoms of mitral valve stenosis

Symptom

Cause

Shortness of breath (dyspnea)

Although the cause of dyspnea is not completely understood, there may not be enough time between heartbeats for the left ventricle to fill with blood, causing blood to back up into the lungs. The increased pressure and fluid in the lungs cause the shortness of breath.

This symptom may be due to or made worse by the development of an abnormal heartbeat (arrhythmia), particularly atrial fibrillation.

Fatigue or weakness

Little by little, the heart becomes unable to pump enough blood, reducing oxygen and nutrient supply to the rest of the body.

Pounding of the heart (palpitations)

This may be due to atrial fibrillation or to the heart working harder to maintain its blood output despite a narrowed valve.

Coughing up blood (hemoptysis)

Veins in the lungs may bleed, usually due to increased blood pressure in the lungs.

You may not have any symptoms until an aggravating event—such as exercise, stress, pregnancy, infection, or an irregular heartbeat—occurs. Or you may have only a few symptoms, regardless of how far the stenosis has progressed. It is important that your doctor monitor your condition for physical changes in your heart and lungs that you might not be aware of.

Additional symptoms of mitral valve stenosis are related to developing heart failure and include an irregular heart rhythm (most often due to atrial fibrillation).

Other less common symptoms include:

  • Hoarseness and vocal cord paralysis (Ortner's syndrome).
  • Difficulty swallowing (dysphagia).
  • Chest pain.
  • Skin color changes, such as pink to purple shades of the cheeks (mitral facies) or dark bluish hues in various areas of the body due to reduced blood flow (cyanosis). Skin color changes occur rarely and usually only in the end stages of the disease.

Because these symptoms could be caused by various heart and lung problems, it may be difficult at first to connect them to mitral valve stenosis.

Symptoms may not become severe for years after they first become noticeable. It is often one or more complications of mitral valve stenosis that leads to its diagnosis.

What Increases Your Risk

The three main risk factors for mitral valve stenosis are:

  • History of rheumatic fever. Unfortunately, since most individuals do not know they had rheumatic fever, they may not know they are at risk.
  • Aging. Wear and tear of the mitral valve over time may cause it to harden and narrow.
  • Gender. More women than men get mitral valve stenosis.

Less commonly, diabetes and Marfan's syndrome can lead to mitral valve stenosis, causing calcification, or hardening, of the mitral valve's base. This limits the valve's flexibility and slows its rhythmic movements. Any condition that scars the valves, such as endocarditis, may lead to mitral valve stenosis. But, these conditions usually raise the chance of getting mitral valve regurgitation rather than stenosis.

Little can be done to prevent mitral valve stenosis. Similarly, after you develop the condition, you cannot prevent the start of symptoms or predict how quickly symptoms will develop.

Fortunately, mitral valve stenosis can be treated. And few people die from it.

When to Call a Doctor

Call 911 or other emergency services immediately if you have:

Call a doctor immediately if you have:

  • Symptoms of heart failure, such as shortness of breath, swelling in the feet and ankles, and dizziness, fainting, fatigue, or weakness.
  • Mitral valve stenosis and you are having symptoms of infection, such as fever with no other obvious cause. Be alert for signs of infection if you have recently have had any dental, diagnostic, or surgical procedure.
  • Fainting episodes.
  • A decreased ability to exercise at your usual level.
  • Excessive fatigue without another explanation.

Watchful waiting

Episodes of chest pain or palpitations may come and go and may not be associated with other serious heart disease. But contact your doctor when:

  • Symptoms get worse.
  • Symptoms persist longer than usual.

Who to see

Health professionals who can evaluate symptoms and order further tests as needed include:

A cardiovascular surgeon may perform surgical repair of heart valves.

Exams and Tests

Mitral valve stenosis is a "quiet" condition—it often has no symptoms in its early stages and may not be diagnosed until you've had the disease for some time. If you are not having symptoms, such as shortness of breath or pounding of the heart, the first sign of mitral valve stenosis could be a suspicious heart murmur that your doctor hears during a routine checkup.

Medical history and physical exam

A review of your medical history and a physical exam can predict whether you have mitral valve stenosis and help determine future treatment. Your doctor will ask about your lifestyle, activity level, and family health history. Your doctor will want to know about any symptoms you are having and if you have ever had:

  • Rheumatic fever, an infection caused by an untreated strep throat infection.
  • Endocarditis, an infection of the lining of the heart's valves and chambers.
  • A congenital heart defect, which is a structural heart problem or abnormality present since birth.
  • Atrial fibrillation, a persistent irregular heartbeat.
  • Symptoms of heart failure, such as shortness of breath, swelling in the feet and ankles, and dizziness, fainting, fatigue, or weakness.

During the physical exam, the doctor will take your blood pressure, check your pulses, listen to your heart (possibly while you are lying on your left side) and lungs, and look for signs of fluid buildup (edema). Findings that may point to a problem with your heart or heart valves include:

  • A distinctive heart murmur—heard best while lying on your left side—and a specific extra heart sound, called an opening snap. These sounds can be easily missed or attributed to other heart or lung conditions, especially in people who are older, overweight, or have preexisting heart conditions.
  • Swelling, especially in the legs, ankles, and feet, due to fluid buildup in the body (edema).
  • Bulging neck veins caused by a backup of blood outside the heart.
  • Fine crackles heard in the lungs, which are evidence of fluid buildup in the lungs.
  • In severe cases, redness or flushing of the cheek area (mitral facies), especially in people who have fair complexions.

Echocardiogram

An echocardiogram is used to find out whether mitral valve stenosis is present and to estimate its severity. Echocardiography uses high-pitched sound waves to produce an image of the heart. Specifically, an echocardiogram can show structural problems of the heart that may affect the mitral valve.

Transesophageal echocardiography is often used in people when evaluating the heart through a thick chest wall is difficult. For this procedure, a device that uses ultrasound waves to produce an image of the heart is inserted through the mouth and down the throat into the esophagus. This test is often used—at the end of a mitral valve surgery, before the surgeon closes the incision—to see whether the valve is working properly.

Echocardiography should be considered if the doctor suspects mitral valve stenosis, whether or not symptoms are present, or if you have associated conditions such as heart failure or atrial fibrillation.

Your doctor can use an echocardiogram to:

  • View the mitral valve opening and closing.
  • Measure the size of the valve opening. A normal mitral valve opens between 4.0 cm2 and 5.0 cm2. Technically, stenosis is present when the valve area is less than 4.0 cm2. Symptoms do not usually develop until the mitral valve opens less than 2 cm2. And no intervention is usually required until it is less than 1.0 cm2 to 1.5 cm2.1
  • Indirectly measure the pressure on the valve to find out the severity of mitral valve stenosis.
  • View the general appearance and function of the left ventricle, the heart's main pumping chamber.
  • Assess how much the leaflets of the mitral valve are damaged.
  • Estimate the blood pressure in the pulmonary arteries.
  • Assess the condition of the other heart valves.
  • Measure the size of the left atrium.

You will likely have regular echocardiograms so your doctor can keep track of any changes in your condition. How often you get an echocardiogram depends on the severity of your mitral valve stenosis. Your doctor may recommend an echocardiogram every year if you have severe stenosis, every 1 to 2 years if you have moderate stenosis, or every 3 to 5 years if you have mild stenosis.1

An echocardiogram can also help determine whether other heart conditions are also present, such as mitral valve regurgitation or aortic valve regurgitation.

Electrocardiogram

Electrocardiogram is used to measure the electrical activity in the heart by attaching small metal discs called electrodes to the chest, arms, and legs. The electrodes are also connected to a machine that translates the electrical activity into line tracings on paper. These tracings are often analyzed by the machine and then carefully reviewed by a doctor for abnormalities. This test is usually part of the standard evaluation of a person with symptoms of mitral valve stenosis.

An electrocardiogram (EKG or ECG) can:

  • Verify how your heart is beating and whether it is in normal sinus rhythm.
  • Help determine whether the heart chambers are enlarged.
  • Screen for evidence of heart attack or poor blood flow to the heart (ischemia).

Chest X-ray

A chest X-ray may show evidence of mitral valve stenosis, such as enlargement of the upper left heart chamber (left atrium), enlargement of the pulmonary arteries, and too much blood and backup of fluid in the lungs (pulmonary edema). Calcium deposits on the heart valves sometimes may be seen on a chest X-ray, especially if the buildup is severe.

An EKG and chest X-ray find evidence of mitral valve stenosis only if it has caused other problems. These include enlargement of the heart (dilation), a thickened heart muscle (hypertrophy), an abnormal left atrium, an irregular heartbeat (arrhythmia), or an insufficient blood flow to the heart (ischemia).

Cardiac catheterization

Cardiac catheterization is usually done before any surgery for mitral valve stenosis to evaluate your heart, the degree of stenosis, and the heart (coronary) arteries. During a cardiac catheterization, the pressure in the heart chamber above the mitral valve (left atrium) is compared to the pressure in the chamber of the heart below the mitral valve (left ventricle). A large pressure buildup in the left atrium confirms the diagnosis of mitral valve stenosis and helps determine how severe it is.

This test may be needed when results of echocardiography are inconclusive or inconsistent with your symptoms. This test can help find out the severity of your mitral valve stenosis. It can also identify other heart conditions that may cause symptoms similar to mitral valve stenosis. For example, it can evaluate the coronary arteries and check for coronary artery disease. Knowing the condition of the coronary arteries may affect later treatment decisions for mitral valve stenosis.

More Information:

Treatment Overview

Key points

Treatment of mitral valve stenosis depends on the severity of your symptoms, which can take 10 to 40 years to occur. If you don't yet have symptoms or you have mild, stable symptoms, your doctor may only monitor your condition with periodic echocardiograms. As the valve narrows, symptoms will start or get worse. Repair or replacement of the valve will be needed to prevent complications such as heart failure.

As you review your treatment options, think about the following:

  • Monitoring your condition may be all that's needed before you have symptoms or if you have only mild, stable symptoms.
  • After symptoms start, your doctor may prescribe medicines to treat them and to prevent complications.
  • During monitoring, if your doctor detects increased pressure in your heart and lungs, increased narrowing of the valve, or if your symptoms become severe, your mitral valve will need to be repaired or replaced.
  • Whether your valve can be repaired or replaced depends on the condition of the valve. If it is damaged beyond repair, it will need to be replaced with an artificial valve.
  • Repair can be noninvasive (balloon valvotomy) or require open-heart surgery (open commissurotomy). Replacement requires open-heart surgery.

Initial treatment

Mitral valve stenosis develops slowly. As the valve narrows, the heart initially compensates by pumping harder. Eventually pressure builds in the upper left side of your heart (left atrium) as more and more force is needed to push blood across your narrowing mitral valve. This eventually stretches the atrium's walls, weakens the heart, and leads to heart failure. For most people, it takes 10 to 20 years for the mitral valve to narrow enough to produce symptoms. This is called the asymptomatic phase. But if your heart adjusts to the narrowed valve, you may not have symptoms even after your valve has narrowed.

Symptoms most commonly develop when unusual stress places an extra burden on your heart. For example, hard exercise can bring on symptoms. Symptoms in women may develop during pregnancy because of the increased demands that pregnancy makes on the heart.

Ongoing treatment

Your doctor may prescribe medicines to manage the symptoms of mitral valve stenosis that you've developed, such as shortness of breath, and to prevent and treat complications that may develop. These medicines may include:

  • Diuretics ("water pills"), which reduce fluid retention and related swelling and which also may lower blood pressure in the upper left heart chamber (left atrium) and relieve breathing difficulties.
  • Antiarrhythmics such as digoxin, beta-blockers, or calcium channel blockers, to slow and regulate an irregular and sometimes rapid heartbeat (atrial fibrillation).
  • Anticoagulants, such as warfarin, for atrial fibrillation.

Treatment if the condition gets worse

As your mitral valve stenosis gets worse, there will come a time when your doctor will advise repairing or replacing your mitral valve.

Mitral valve repair may be done in one of two ways:

  • Balloon valvotomy. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, so recovery is easier.
  • Open commissurotomy. This method of repair requires open-heart surgery. A surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.

Mitral valve replacement surgery is also an open-heart procedure. The damaged heart valve is removed and replaced with a new valve. It is generally the last choice in mitral valve stenosis treatment, because an artificial mitral valve cannot work as well as a normal mitral valve.

Your doctor will likely recommend valve replacement if the valve has deteriorated to the point that repair is not an option or if the anatomy of the valve has been changed by one or more repair procedures and can no longer be repaired.

See a picture of mitral valve replacement surgery.

Before you have valve replacement surgery, you and your doctor will decide on which type of valve is right for you. To help with this decision, see:

Click here to view a Decision Point. Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Ongoing Concerns

After you develop symptoms of mitral valve stenosis, it usually takes about 3 to 10 years before they become disabling. As long as your symptoms are mild or stable, your doctor may be able to keep them under control with medicines. As your symptoms increase and your valve width decreases, surgery to repair or replace the valve will become necessary.

Complications

Mitral valve stenosis can be an easy condition to overlook in its mild form. But as it progresses, it often has serious complications. The most common complications are an irregular heartbeat (arrhythmia), heart failure, an infection in the heart (endocarditis), and stroke. All of these are serious medical conditions that require treatment. And you and your doctor will need to discuss the most appropriate ways to prevent and treat them.

For more information, see the topics Heart Failure, Atrial Fibrillation, and Endocarditis.

More Information:

Living With Mitral Valve Stenosis

Serious heart damage can result from long-term mitral valve stenosis. If you have been diagnosed with the condition, be sure to talk to your doctor about how often you need to be examined.

Symptoms

Be especially alert for new symptoms or symptoms getting worse, such as:

  • Shortness of breath.
  • Pounding of the heart.
  • Unusual fatigue.
  • Dizziness.
  • Fainting.
  • Chest pain.

Call your doctor if your symptoms get worse or if new symptoms start.

Exercise

People who have severe mitral valve stenosis may need to be cautious about their level of physical activity. If you don't exercise, talk to your doctor before you start. You may be able to do certain types of exercise that don't put undue strain on your heart.

If you don't have symptoms, discuss exercise with your doctor. If your stenosis is mild, normal activities, mild exercise, and in some cases competitive sports may be allowed. But if your stenosis is moderate or severe and you have symptoms, you should avoid strenuous activity. You may be able to do low-level activities to help keep your heart healthy.

If you have a physically demanding job, you may need to change careers. Talk with your doctor to find out your safe level of activity.

Diet

Depending on how bad your condition and symptoms are, your doctor may advise you to limit salt in your diet to less than 2,300 mg a day. If you consume too much sodium, it will cause your body to retain excess fluid. Excess fluid in the body will cause swelling, breathing difficulties, fatigue, and other unpleasant side effects.

Salt restriction usually includes avoiding potato chips, pretzels, salted nuts, processed meats and cheeses, pizza, canned soups, canned vegetables, olives, fast foods, and frozen dinners (unless the label clearly states the product is low-sodium). Add more fresh fruit and vegetables to your diet to replace foods high in sodium.

When you are grocery shopping, check labels carefully for hidden sodium.

Antibiotics

If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis.

Anticoagulants

If you take an anticoagulant (also called a blood thinner), such as warfarin, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:

Click here to view an Actionset. Warfarin: Taking Your Medicine Safely.

More Information:

Medications

Medicines are often used to relieve the symptoms and prevent complications of mitral valve stenosis. Usually they are also prescribed after you have surgery to repair or replace your mitral valve.

Medicines to treat symptoms include:

  • Diuretics. Diuretics ("water pills") are usually prescribed to reduce fluid retention and related swelling. They may also lower blood pressure in the upper left heart chamber (left atrium) and relieve breathing difficulties.

Medicines are used to treat complications. Complications may include:

  • Irregular heartbeats. Digoxin, beta-blockers, calcium channel blockers, and other antiarrhythmics may be used to slow and regulate an irregular and sometimes rapid heartbeat (atrial fibrillation). Anticoagulants, also called blood thinners, are used to reduce the risk of stroke in atrial fibrillation.
  • Infections. If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis. You will likely take antibiotics after surgery to repair or replace a valve. If you have had rheumatic fever, you may take antibiotics to avoid getting it again.
  • Blood clots. Anticoagulants (also called blood thinners), such as warfarin, can lower your risk of stroke by preventing the formation of potentially harmful blood clots. Anticoagulants are needed after surgery that repairs or replaces a valve. If you take an anticoagulant, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:
    Click here to view an Actionset. Warfarin: Taking Your Medicine Safely.
  • Heart failure. Diuretics, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) help lower blood pressure, reduce fluid buildup in the lungs, and therefore ease strain on the heart. Digoxin is used to slow a rapid and irregular heartbeat. It also increases the heart's ability to contract, which can increase cardiac output. Used with caution, beta-blockers may be given to ease the heart's workload by reducing the amount of blood the heart needs and by slowing the heart rate, which allows more time for blood to pass through the narrowed mitral valve.

What to think about

Talk with your doctor about the need for medicine. If you have used the now-banned, weight-loss medicine fen-phen, there may be specific concerns about your heart valves.

Surgery

If medicines are not effective in controlling your symptoms of mitral valve stenosis or if your doctor determines that you need more aggressive treatment, you may need surgery to repair or replace your mitral valve. Valve surgery is common and usually successful. But a degree of risk is associated with this invasive procedure. There are generally three options: a balloon valvotomy, a closed (or open) commissurotomy surgery, or valve replacement surgery.

Valve repair (balloon valvotomy)

Balloon valvotomy (percutaneous mitral balloon valvotomy) is the method of choice for treating mitral valve stenosis in select patients. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, so recovery is easier.

A balloon valvotomy is usually recommended if you have symptoms, moderate to severe stenosis, and most of your mitral valve is a normal shape.

A balloon valvotomy may also be used to treat people with mitral valve stenosis who do not yet have symptoms (asymptomatic) if they have:1

  • A higher risk of dangerous blood clots (thromboembolism). This includes people with an irregular heart rhythm called atrial fibrillation, as well as those who have had a blood clot before.
  • High blood pressure in the lungs (pulmonary hypertension).
  • Mitral valves that are still in fairly good condition.

Your doctor may recommend a balloon valvotomy if you are planning to have another surgery (not on your heart), if you are pregnant, or if you are planning a pregnancy.

People with signs of blood clots in the left atrium, widespread calcification of the mitral valve structures, or moderate to severe mitral valve regurgitation are not considered good candidates for a balloon valvotomy.

The mitral valve may narrow again (restenosis) after 10 to 20 years.

Valve surgery

Depending on the amount of damage to your mitral valve, your doctor may recommend surgery to repair or replace your mitral valve. If the valve is damaged beyond repair, it will need to be replaced. Mitral valve surgery may be done as an open-heart surgery, or a minimally invasive surgery.

During open-heart surgery, your heartbeat is stopped, and you are placed on a heart-lung machine to deliver blood to your body. The heart-lung machine temporarily serves in place of your heart and lungs by mixing oxygen with the blood, removing carbon dioxide from the blood, and pumping the blood throughout your body.

During minimally invasive surgery, your doctor makes a smaller incision than the incision made in open-heart surgery. You may still be placed on a heart-lung machine. Valve repair or replacement is similar for minimally invasive surgery and open-heart surgery.

Valve repair

In open commissurotomy, a surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.

Valve replacement

The damaged heart valve is removed and replaced with a new valve. This is generally done when your mitral valve is damaged beyond repair. With improved technology, mitral valve replacement is an important surgical option. Some doctors believe that replacement mitral valves are now more durable. Also, more of the original mitral valve and its support structure (such as the chordae tendineae) are preserved during valve replacement. The long-term results of surgery are generally better when more of the original mitral valve structure is preserved.

Deciding about valve surgery

Replacement heart valves

If you have valve replacement surgery, a mechanical or tissue valve will be used to replace your heart valve. Before you have surgery, you and your doctor will decide on which type of valve is right for you. To help with this decision, see:

Click here to view a Decision Point. Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Most people who have mitral valve replacement surgery will receive a mechanical heart valve. Even if a bioprosthetic tissue valve is used, you will need to take anticoagulants if you also have other heart conditions such as abnormal heartbeat (arrhythmia) or a dilated left atrium, because both of these conditions are risk factors for stroke.

If you receive a mechanical valve, you are more likely to develop blood clots in the heart than if you received a tissue valve. So you will need to take an anticoagulant medicine, such as warfarin, for the rest of your life. For more information about taking warfarin, see:

Click here to view an Actionset. Warfarin: Taking Your Medicine Safely.

More Information:

Other Places To Get Help

Organizations

Society of Thoracic Surgeons
 
633 North Saint Claire Street
Suite 2320
Chicago, IL 60611
Phone: (312) 202-5800
Fax: (312) 202-5801
Email: sts@sts.org
Web Address: www.sts.org
 

The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the Web site describes diseases, surgeries, patient options, and what to expect after surgery. And using the Web site, you can search for surgeons in your area.


American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

Texas Heart Institute
P.O. Box 20345
Houston, TX  77225-0345
Phone: 1-800-292-2221 (Heart Information Service hotline)
(832) 355-4011 (general line)
Email: his@heart.thi.tmc.edu (Heart Information Services)
Web Address: www.texasheartinstitute.org
 

The Texas Heart Institute's national telephone hotline is staffed by medical professionals who can answer heart-related health questions. The Web site provides information on a wide range of heart topics, including common disorders and prevention programs.


References

Citations

  1. Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84–e231.

Other Works Consulted

  • Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15): e523–e661.
  • Curtin RJ, Griffin BP (2006). Valvular heart disease. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap. 11. New York: WebMD.
  • Nishimura RA, et al. (2008). ACC/AHA 2008 guideline update on valvular heart disease: Focused update on infective endocarditis: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 118(8): 887–896.
  • Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253–256.
  • Otto CM, Bonow RO (2008). Mitral stenosis section of Valvular heart disease. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1646–1657. Philadelphia: Saunders Elsevier.
  • Rodriguez L, Gillinov AM (2007). Mitral valve disease. In EJ Topol, ed., Textbook of Cardiovascular Medicine. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Revised January 31, 2011

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