An 11 year old bubbly young girl, so full of life, chasing her dreams found herself crippled after she developed rheumatic mitral valve disease. She was breathless, had palpitations and was tied to the confines of her bed. She presented to us with such severe symptoms and underwent successful surgical repair that restored her functional status.
A diseased mitral valve can have 2 basic kinds of problems:
1) Regurgitation / backflow occurs if the valve doesn't co apt tightly. Blood leaks back into the chambers rather than flowing forward.
2) Stenosis occurs if the flaps of the valve thicken, stiffen or fuse together. This prevents the heart valve from fully opening. As a result not enough blood flows through the valve.
Some children are born with a diseased valve (congenital) while others acquire it later in life (rheumatic). Untreated streptococcal throat infections that progress to rheumatic mitral valve disease accounts for the major chunk of such cases. The common signs and symptoms of mitral valve disease relate to heart failure. These include:
- Unusual fatigue
- Shortness of breath
- Swelling in the ankles, feet, legs, and abdomen
- Irregular heart beat/ dizziness
A thorough physical examination, a chest radiograph and 2D echocardiography clinches the diagnosis. Currently no medicines can cure heart valve disease. Lifestyle changes and decongestive measures provide symptomatic relief only.
Definitive therapy is an open heart surgery on bypass. The decision to repair or replace the valve depends on the severity of the valve disease, the age and co-morbidities. Whenever possible, mitral valve repair is preferred over replacement with a prosthetic valve. The 2 most common surgical mitral valve repairs are ring annuloplasty and surgical reconstruction.
Surgically repairing the valve spares the surrounding structures that attach the valve to the heart. In addition, such patients do not need long term blood thinners. Recovery time is much quicker. Avoiding the insertion of synthetic materials severely reduces the risk of infection and thrombo-embolic complications.
In our pediatric division, we have performed mitral valve repair in a series of 130 patients since 2009 only 7 patients required re-do surgery for residual stenosis or regurgitation and 6 had grade 2 regurgitation on follow up.
Remember, replacing a valve means removing a disease and giving another. This concept has driven a revolution in mitral valve surgery that has swept our field in recent decades.
Article by Dr. Prashant Shah & Dr. Lakshmi Prashant
Dr. Prashant Shah, MS, DNB, CTVS
Chief Consultant Congenital Cardiac Surgeon, Kauvery Hospital
Dr. Lakshmi Prashant, MD (AIIMS)
Consultant Pediatrician, Kauvery Hospital