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By Minh Nugyen OMS III Western University of Health Sciences-Pomona, CA

Mitral Valve Prolapse and When to Have Surgery

What is mitral valve prolapse?

The mitral valve consists of two flaps that open and allow blood flow from the left atrium to the left ventricle. It prevents backward flow into the left atrium when it closes. In mitral valve prolapse, one or both flaps of the valve collapse backward into the left atrium and unable to close completely. In some cases, this lets a small amount of blood lead backward through the valve, and may cause a murmur.

mitral-valve

Is mitral valve prolapsed dangerous?

            No, in most cases, mitral valve prolapse does not affect one’s health. However, in some cases where mitral valve prolapse becomes worse and causes significant valve leakage, or regurgitation, treatment is required.

When is surgery indicated for mitral valve prolapse?

According to the ACC/AHA, repair of mitral valve is recommended over replacement in most patients with moderate-to-severe or severe chronic mitral regurgitation:

Symptomatic

  • New York Heart Association (NYHA) functional Class II-IV symptoms without severe LV dysfunction (EF ≥0.30 and/or end-systolic dimension ≤55 mm) (Class I).
  • Chronic severe MR due to a primary abnormality of the mitral valve apparatus and NYHA functional Class III-IV symptoms and  mild-to-moderate LV dysfunction (EF < 0.30 and/or end-systolic dimension >55 mm) in whom MV repair is highly likely (Class IIa).

Asymptomatic

  • Asymptomatic patients with chronic, severe MR and mild-to-moderate LV dysfunction (EF 0.65 and/or end-systolic dimension ≥45 mm) (Class I).
  • Mitral valve repair is reasonable in experienced centers for asymptomatic patients with chronic severe MR with preserved LV function (EF >0.65 and end-systolic dimension < 45 mm) in whom the likelihood of successful repair without residual MR is greater than 90% (Class IIa).
  • Surgery is reasonable for asymptomatic patients with chronic severe MR, preserved LV function, new onset atrial fibrillation, or pulmonary artery hypertension (pulmonary artery systolic pressure >50 mm Hg at rest or >60 mm Hg with exercise) (Class IIa).

 

For more information, visit: http://emedicine.medscape.com/article/155618-treatment#a1128

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