Some patients are born with defective heart valves that affect blood flow through the heart. In addition, infection, rheumatic fever and the aging process can damage healthy heart valves. Surgeons at GW Hospital are recognized nationally for their expertise in valvular surgery. They perform innovative valve repair and replacement procedures using advanced surgical techniques, valve devices and prostheses.

Minimally Invasive Valve Procedures

Surgeons at The George Washington University Hospital use an innovative minimally invasive technique — called port access — to repair or replace valves.

Like traditional bypass surgery, conventional valve surgery requires a major incision in the chest and separation of the breastbone. During a port access procedure, however, surgeons leave the breastbone intact and access the heart through a small incision under the breast.

This approach can’t be used in all patients, but those who undergo minimally invasive surgery usually have shorter hospital stays, quicker recoveries and less scarring.

Port access techniques also can be used to treat a patient who has both a valve defect and a tumor in the heart or a hole in the wall that divides the heart.

The Mitral Valve

The mitral valve is a heart valve between the left atrium (upper chamber of the left heart) and the left ventricle (lower chamber of the left heart). Consisting of two flaps, or leaflets, it acts as a doorway for the blood to go from the left atrium to the left ventricle every time the heart beats. The mitral valve opens during diastole (the part of cardiac cycle when the heart relaxes) and allows oxygen rich blood from the lungs to flow from the left atrium to the left ventricle that gets filled with this oxygen rich blood in preparation to pump it to the rest of the body. When the left ventricle starts to contract during systole (the part of cardiac cycle when the heart pumps out the blood), the mitral valve closes so that the blood does not go backwards into the left atrium and the lungs.

Any disease that affects the mitral valve leaflets can cause a leaky mitral valve. The most common cause is myxomatous degeneration of the mitral valve. In this process, the mitral valve leaflets, which are normally very thin and pliable, become thickened. Other causes include dysfunction of the left ventricle from coronary heart disese or enlargement and infections that weaken the mitral valve. 

Symptoms 

  • Shortness of breath after exertion that develops over the course of months or years
  • Irregular heart rhythm can be the first sign of a leaky mitral valve
  • High pulmonary (lung) artery pressures

Mitral Valve Repair

Mitral valve repair is the recommended operation for leaky mitral valves. Most leaky valves can be repaired using the patient’s own tissues. Depending on the damage, a surgeon can either tighten the valve by sewing a ring around it or rebuild one or both of the flaps that open and close the valve.

Mitral Valve Replacement

For the mitral valves that cannot be repaired, replacement with an artificial valve is another option. There are two types of mitral valve prosthesis that are used:

Bioprosthetic valves (Biological valves)

  • These are either bovine (cow) tissue or procine (pig) tissue valves. The advantage of tissue valves is that they do not require patients to be on long term anticoagulation (blood thinning medications such as warfarin), reducing the risks patients face with blood thinning medications. The disadvantage is their functional deterioration (structural valve deterioration) can lead to the valve not functioning properly and the patient requiring another operation to replace the malfunctioning artificial biological valve.

Mechanical valves (metal valves)

  • These are artificial valves that are made of a metal. The advantage of a mechanical valve is that, typically, these valves last for the patients’ life time. The disadvantage of these valves is that they have a tendency to form clots and patients need to stay on life-long anticoagulation medication (blood thinners).