Women's Heart Advisor October 2017 Issue

A Floppy Mitral Valve May Not Be Serious

When the valve leaks, though, itís time to see a cardiologist.

An estimated 2-3 percent of the population has a condition called mitral valve prolapse. This means the valve separating the heart’s left atrium from left ventricle is floppy. This prevents it from snapping neatly back into place between contractions.

Mitral valve prolapse used to be considered a woman’s problem, but it affects men as well. Most people with mitral valve prolapse have no symptoms and are unaware they have it. That’s okay, because the condition is not serious, unless the valve develops a severe leak. “If the valve doesn’t leak, or only leaks a little bit, no treatment is needed. You can continue your normal activities,” says A. Marc Gillinov, MD, Cleveland Clinic’s Chairman of Thoracic and Cardiovascular Surgery.

How a Leaky Valve Is Diagnosed

The mitral valve is one of four valves inside the heart that keep blood flowing smoothly in one direction. In some patients with mitral valve prolapse, the valve becomes so loose that blood leaks backwards. Doctors call this regurgitation. “It can mean the valve has become excessively floppy. In most cases, this means that one of the chords holding the valve has ruptured or lengthened,” Dr. Gillinov explains.

Mitral valve prolapse is generally diagnosed when a general practitioner, internist or ob/gyn hears an abnormal sound through the stethoscope. This sound, called a murmur, indicates the valve is leaking.

Some leaky valves are discovered during a routine examination. Others are diagnosed when a patient comes to the doctor complaining of fatigue, shortness of breath, dizziness, or palpitations—all potential symptoms of a leaky valve.

Either way, a murmur should prompt a referral to a cardiologist.

“These patients need to be monitored with a yearly echocardiogram,” says Dr. Gillinov. “If the leak becomes severe, it needs to be addressed surgically.”

Valve Repair Wins

A mitral valve may be repaired or replaced to prevent it from leaking. Most cardiac surgeons perform valve replacement, but valve repair requires expertise that is not available in every community. Cleveland Clinic performs more mitral valve repairs than any other location in North America.

“It’s easier to replace a mitral valve, but better to repair it,” says Dr. Gillinov.

“With valve repair, patients tend to live longer, do not need to take anticoagulants and are less likely to develop a valve infection.”

A valve repair is durable, too, producing a permanent fix in 80 to 90 percent of patients.

“Most of the time, an isolated repair can be done robotically or minimally invasively,” adds Dr. Gillinov. †

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