American Medical Association Family Medical Guide - American Medical Association [345]
If your mitral stenosis is severe and interferes with your daily activities, your doctor may recommend a surgical procedure called balloon valvuloplasty. In this procedure, the doctor guides a catheter (a thin, flexible tube) through an artery to the damaged valve. He or she then guides a tiny deflated balloon through the catheter to the valve and then inflates the balloon, opening the valve. This procedure is highly effective in relieving symptoms of mitral stenosis.
Doctors may recommend surgery for pregnant women who have severe symptoms of mitral stenosis. In an open-heart procedure called mitral valvotomy, the surgeon widens the valve. In many cases, symptoms do not return, or return years later. If your symptoms return, you may need to have a second mitral valvotomy, or your doctor may recommend heart valve replacement surgery (see page 590). Most people who have a heart valve replacement survive for at least 5 years.
If your symptoms are not severe, you should be able to lead an active life without treatment. However, you will need to take prescription antibiotics as a precaution before having any dental treatment or surgery, to protect you from developing infective endocarditis (see page 593), a potentially life-threatening infection of the inner lining of the heart muscle.
Balloon valvuloplasty
In balloon valvuloplasty, the surgeon inserts a catheter (a thin, flexible tube) into an artery in the groin area and threads the catheter to the damaged heart valve. He or she then guides a tiny deflated balloon through the catheter to the valve and inflates the balloon, opening the valve. The balloon is then deflated and withdrawn along with the catheter.
Mitral Regurgitation
If the mitral valve does not close properly, the blood circulating through the heart may leak back into the left atrium (one of the two upper chambers of the heart) from the left ventricle (one of the two lower, pumping chambers of the heart). This condition, called mitral regurgitation or mitral insufficiency, increases the heart’s workload, causing the muscular heart wall to enlarge. The left atrium also becomes enlarged.
Mitral regurgitation often results from an abnormality of the mitral valve called mitral valve prolapse (see page 591), which causes the valve to move abnormally when the ventricles contract. When the valve flaps do not meet to close, blood leaks back through the opening. Mitral regurgitation may be congenital (present at birth), or it may result from infective endocarditis (see page 593), a potentially life-threatening infection of the inner lining of the heart muscle, or from any heart muscle disorder that causes the left ventricle to enlarge and widen.
Symptoms
Many people who have mitral regurgitation have no symptoms. Others may experience shortness of breath, fatigue, or other symptoms of congestive heart failure (see page 570). The increased workload on the heart can permanently damage the left ventricle, preventing it from contracting properly and interfering with its ability to pump blood. If this occurs, the doctor will probably recommend replacing the valve. As the left atrium becomes enlarged, atrial fibrillation (see page 581) usually occurs.
Treatment
Treatment for mitral regurgitation is not necessary unless a person has symptoms. If you have mitral regurgitation, your doctor will prescribe antibiotics for you to take before having surgery or dental treatment to protect you from infective endocarditis.
Your doctor may prescribe a diuretic to help your body eliminate excess fluid and decrease swelling. However, because diuretics may also cause loss of potassium (a mineral that is essential for the heart muscle to contract and maintain a normal heart rhythm), your doctor also may prescribe a potassium supplement.
If your symptoms are severe, your doctor may recommend surgery to repair or replace the damaged valve (see next page). Although repairing the valve is preferable, it is not always possible. Replacement heart valves are either mechanical valves made of metal and plastic, or tissue valves