Cardiothoracic Conditions

Mitral Valve Conditions

Overview of Mitral Valve Prolapse

Mitral valve prolapse is a common condition in which the mitral valve leaflets are floppy or loose. Mitral valve prolapse is diagnosed by echocardiography (EKG) which records the heart's electrical activity. Most patients with mitral valve prolapse do not have a leaky mitral valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should be considered.

 Illustration of the mitral valve

In a normal valve, the flow of blood goes from the left atrium to the left ventricle. Upon closing, it prevents blood from going back into the left atrium. With MVP the flaps fail to close evenly. One or both flaps collapse backwards, sometimes allowing a small amount of blood to leak through the valve.

Mitral valve prolapse, sometimes known as mitral insufficiency or mitral valve regurgitation, is a genetic disorder and seems to affect women three times more than men. It is one of the most common cardiac conditions.

Mitral Valve Prolapse Treatment and Surgical Options

The treatment and surgical options for mitral valve prolapse depend on the severity of the condition, your symptoms and overall health. If you are not having symptoms or if your symptoms are mild, your doctor may suggest medication, lifestyle changes or no treatment at all.

Surgery

If your symptoms become severe, your doctor may recommend mitral valve surgery. The goal of surgery is to allow your valve to open and close properly. There are two common types of mitral valve surgery: valve repair and valve replacement.

With valve replacement, your surgeon cuts out the damaged valve and replaces it with a new, artificial valve. The new valve may be mechanical (from man-made materials) or biological (from human or animal tissue). With valve repair, your surgeon rebuilds one or more of the valve leaflets using your own tissue.

Your doctor will fully explain the pros and cons of replacing your valve versus repairing your valve.

During mitral valve surgery, a heart-lung machine is used. This machine temporarily takes over the function of your heart and lungs during surgery. It provides surgeons with a still and blood-free surface during the procedure.

Whether repairing or replacing your valve, surgery may be performed using open surgery through a large chest incision or minimally invasive surgery through a few small incisions.

Open Surgery

During open surgery, doctors make a large chest incision and cut through your breastbone (sternum) to reach your heart. The incision must be large enough for your surgeon to fit his or her hands and surgical instruments inside your chest. Open surgery allows your surgeon to see and touch your heart and tissues. While open surgery allows your surgeon to see and touch your organs, it is invasive due to the large incision.

Minimally Invasive Surgery

Thoracoscopic Mitral Valve Surgery

During thoracoscopically-assisted surgery, doctors repair or replace your defective valve through one or more small incisions instead of a large incision through the breastbone. Long, thin surgical instruments, including a tiny camera, are inserted through the incisions to reach your heart. The camera takes images inside your chest and sends them to a video monitor to guide surgeons as they operate.

da Vinci Mitral Valve Repair Surgery

Another minimally invasive surgical option is da Vinci Surgery. The da Vinci Surgical System uses the latest in surgical and robotics technologies. da Vinci is beneficial for complex surgery. With da Vinci Surgery you avoid the large chest incision used with open surgery.

da Vinci is a state-of-the-art surgical system that features a magnified 3D high-definition vision system and special wristed instruments designed to take surgery beyond the limits of the human hand. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. Physicians have used the da Vinci System successfully worldwide in hundreds of thousands of procedures to date.


The clinical evaluation of the da Vinci Surgical Systems (Models (S1200, IS2000, IS3000) supporting its use for mitral valve repair was not performed totally endoscopically. Introduction and manipulation of the endoscopic instruments were controlled by the da Vinci Surgical Systems through port incisions (< 1 cm) while accessory technologies, e.g., atrial retractor and cardioplegia line, etc, were introduced through a mini-thoracotomy. Performance characteristics for conduct of totally endoscopic mitral valve repair using the da Vinci Systems have not been established.


All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php.

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