Mitral Valve Disorders

One of the heart's four valves, the mitral valve is located between the heart's upper chamber, called the left atrium, and the heart's lower chamber, called the left ventricle.

Valves control the blood flow through the heart. The mitral valve controls the blood flow from the left atrium into the left ventricle. When the heart contracts, the mitral valve closes to prevent blood from backing up into the lungs. If the valve becomes diseased or damaged, it may be surgically repaired to restore function.

Heart surgeons at the UCSF Heart and Vascular Center are leading experts in the surgical repair of mitral valve disorders. They also offer early mitral valve repair before the heart is severely damaged by the faulty valve.

If left untreated, mitral valve disease may lead to more serious problems, such as heart dilation, in which the heart's walls become stretched and weakened. As a result, heart rhythm problems may occur, including atrial fibrillation. In some cases, the mitral valve is so damaged it cannot be surgically repaired. Our surgeons also specialize in replacing the damaged mitral valve with an artificial or natural valve.

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Types of Mitral Valve Disorders

The two most common conditions that require mitral valve repair include:

  • Mitral Valve Prolapse — Myxomatous degeneration of the valve, also known as "floppy valve" or mitral valve prolapse, is the most common condition that requires mitral valve repair. It occurs when the mitral valve leaflets become floppy or loose and the valve does not open and close properly. In most cases, it does not cause symptoms and therefore treatment is not required.

    However, in more severe cases, the condition may cause mitral valve regurgitation, in which the blood leaks backwards into the lungs. This may result in heart dilation, in which the heart's walls become stretched and weakened. As a result, heart rhythm problems may occur, including atrial fibrillation. Almost all of leaky valves caused by myxomatous degeneration can be successfully repaired with surgery.
  • Mitral Valve Stenosis — Mitral valve stenosis is a narrowing of the opening of the mitral valve, which can prevent the valve from opening and closing normally, reducing the amount of blood flow through the heart. Over time, stenosis can cause high blood pressure in the left atrium and the lungs, which can lead to breathing difficulties.

Other conditions that may require mitral valve repair include:

  • Endocarditis — This is an infection affecting the heart valves or the inner surface, called the endocardium, of the heart. Endocarditis typically occurs when bacteria or other germs in the mouth, intestinal tract or urinary tract travel to the heart via the bloodstream and lodge in the heart. These bacteria usually don't cause problems in normal hearts, but hearts with defects or those that have been repaired are vulnerable to infection. Once infection occurs, the bacteria continue to grow and may seriously damage the heart.
  • Heart Failure — Heart failure develops when the heart doesn't function properly. The names "heart failure" and "congestive heart failure" (CHF) often confuse people since the heart hasn't actually "failed" or stopped. Heart failure is a medical term that describes the condition in which one or more chambers of the heart "fail" to keep up with the volume of blood flowing through them. Heart failure can be brought on by a variety of underlying diseases and health problems.

    Patients with end-stage heart failure who have severe regurgitation — in which the blood leaks backwards into the lungs — may require mitral valve repair. However, many of these patients will eventually need a heart transplant.

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Surgical repair of a malfunctioning mitral valve is recommended when it causes symptoms such as shortness of breath, fatigue, chest pains, dizziness, swelling of the ankles or legs, cough or heart palpitations. It may also be recommended when the damaged or diseased mitral valve causes the heart muscle to weaken.

The diagnosis of mitral valve disease is confirmed with echocardiography. This is a safe, painless test that uses sound waves (ultrasound) to examine the heart's structure and motion. This test provides information about the heart's pumping ability, blood flow activity, valve function, size and pressure.

UCSF is an international leader in echocardiography and has been at the forefront of developing new techniques and equipment in this field. UCSF cardiac surgeons not only use echocardiography before surgery to diagnose mitral valve disease and plan the procedure, but also during repair.

In many cases, the echocardiography tells surgeons all they need to know to perform the surgery, so that cardiac catheterization — an invasive procedure performed to obtain detailed information about the heart — is not necessary. Cardiac catheterization uses catheters, which are thin, flexible tubes inserted through tiny incisions in the groin or neck and threaded through blood vessels to the heart.

If the mitral valve becomes diseased or damaged, it may be surgically repaired to restore function. Mitral valves also may be replaced with an artificial or natural valve. However, research has shown that there are many advantages of surgically repairing, rather than replacing, a mitral valve. In certain cases, however, the valve may be so seriously damaged that valve replacement is recommended.

Your surgeon will discuss both treatment options with you. The decision regarding whether to have valve repair or replacement depends on a number of factors, including your age, overall health, cause of valve damage and expected benefits of surgery.

Surgical Repair

Mitral valve repair is an open heart procedure performed by a cardiothoracic surgeon, a doctor who specializes in heart and lung conditions.

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Reviewed by health care specialists at UCSF Medical Center.

Related Information

UCSF Clinics & Centers

Heart & Vascular Center

Cardiothoracic Surgery
400 Parnassus Ave., Fifth Floor
San Francisco, CA 94143
Phone: (415) 353-1606
Fax: (415) 353-1312
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Asian Heart & Vascular Center
1600 Divisadero St., Second Floor, Suite C-244
San Francisco, CA 94115
Appointments: (415) 885-3678
Events: (415) 885-3678
Fax: (415) 885-3676
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Echocardiography at Mount Zion
1600 Divisadero St., Second Floor
San Francisco, CA 94115
Phone: (415) 885-7321
Fax: (415) 885-7849
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Echocardiography at Parnassus
505 Parnassus Ave., Suite M344
San Francisco, CA 94143
Phone: (415) 353-1262
Fax: (415) 353-1784
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