The mitral valve is described as the most complex of the heart’s four valves. To match its sophistication, the Froedtert & the Medical College of Wisconsin Comprehensive Mitral Valve Program offers a variety of state-of-the-art treatments. “The feature that sets us apart is that we have the technical and clinical expertise to apply all of the therapies to offer the entire spectrum of care,” said Michael Salinger, MD, interventional cardiologist and MCW faculty.
An Open-and-Shut Case
Positioned between the left atrium and left ventricle, the mitral valve opens to allow oxygen-rich blood to flow from the atrium to the ventricle and then closes when the ventricle contracts to send blood out to the body.
Interrupting the flow
The hardworking mitral valve is the one most commonly affected by disease. Problems fall into three main categories:
- Stenosis — Narrowing of the mitral valve
- Prolapse — Enlarging or bulging of one or both of the valve’s leaflets, allowing a small amount of blood to flow back into the atrium (regurgitation)
- Regurgitation — Incomplete closing of the valve’s leaflets due to congenital causes or disease. Severe cases can lead to heart failure.
A person’s physician may hear a heart murmur, but it does not necessarily indicate disease. When a mitral valve does malfunction, it can place extra strain on the heart and lungs.
“The first thing that happens is that people become short of breath with something that requires minor effort,” said Paul Pearson, MD, PhD, cardiothoracic surgeon and MCW faculty. Disturbances in the heart rhythm can also occur.
Sophisticated diagnostic imaging enables physicians to pinpoint trouble. “The definitive test for mitral valve problems is the echocardiogram,” Dr. Pearson said. The noninvasive test evaluates heart and valve function using sound waves.
“The biggest advancement is three-dimensional echocardiography, called transesophageal echocardiogram,” Dr. Pearson said. “We obtain a 3-D image, as if in the heart, to help us determine if the valve can be repaired or needs replacing.”
Advantages of academic medicine
With all the available resources of academic medicine, the Comprehensive Mitral Valve Program can provide tailored treatments to each patient, including some treatments not readily available at other institutions. Our specialists work collaboratively, using the latest research and weekly valve conferences to gather multiple opinions to ensure patients get the most appropriate treatment recommendations. We also participate in significant clinical research trials to find new and more effective treatments for heart and vascular disease.
A full spectrum of treatments
When possible, surgeons prefer to repair the native valve, rebuilding its chords and leaflets and tightening the annulus (frame) around it.
If a valve needs replacement, surgeons implant either a bioprosthesis made of metal or tissue. Metal valves are durable but can form clots, so patients must take blood-thinning medication. Tissue valves generally do not require blood thinners but eventually wear out. “The choice is based primarily on the patient’s age, but we weigh the benefits and liabilities,” Dr. Pearson said.
Many advances in mitral valve therapy and technology replace open surgery with minimally invasive procedures through an artery or a vein, often referred to as transcatheter procedures. MitraClip®, for example, attaches a dime-sized clip to leaking valve leaflets to reduce the backflow of blood and is intended for patients who are inoperable or at high risk for surgery.
Our physicians also perform a less invasive, catheter-based option to replace the mitral valve in patients with failing tissue valves and who are at high risk for a second open surgery. “With this valve-in-valve procedure, we advance a new crimped valve under X-ray and echocardiogram and expand it within the old surgical prosthesis,” said Peter Mason, MD, MPH, RPVI, interventional cardiologist and MCW faculty. Patients usually go home in one or two days.
Through the Comprehensive Mitral Valve Program, our team of experts has the expertise to tailor treatment specifically to each patient’s needs. “When you use a heart team approach, with that amount of expertise around the table on the patient’s behalf, we leave no stone unturned,” Dr. Mason said.