Physicians have long espoused the wisdom of preventive medicine — and sometimes, that means having surgery before you think you need it.
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This is the case with mitral valve regurgitation, a condition that results when the valve leaflets fail to close tightly, letting blood flow backwards in the heart.
In most cases, doctors detect early mitral regurgitation when they hear a murmur. These patients are generally observed, through regular office visits with their cardiologist and echocardiograms — a practice called “watchful waiting”— until they develop symptoms. At this point, surgery may be discussed. Cleveland Clinic surgeons found that repairing the mitral valve before symptoms appear is a better approach.
“Thanks to modern, less-invasive techniques, patients can benefit from repair before they begin experiencing symptoms such as atrial fibrillation or heart failure,” says Cleveland Clinic cardiothoracic surgeon Joseph Sabik III, MD.
Signs and symptoms worsen
A diseased mitral valve degenerates slowly, so symptoms tend to emerge gradually.
As the disease progresses, patients may begin to notice shortness of breath, especially during exertion or when lying down. They may develop palpitations or swelling in the feet and ankles. Ultimately, they are at risk for heart failure.
No one wants these symptoms, so avoiding them is smart.
No reason to wait
Over time, advances in technique and technology have transformed mitral-valve surgery from an open-heart valve-replacement procedure to a minimally invasive valve-repair procedure, with a shorter hospital stay and less discomfort.
A recent review of nearly 6,000 valve repairs performed at Cleveland Clinic found it to be a low-risk procedure with long-lasting benefits. A good outcome is expected when the surgery is performed in a high-volume center. Therefore, if a patient’s echocardiogram is showing the valve leak is severe, there’s no reason to wait.
“We recommend patients with severe mitral valve regurgitation undergo surgical evaluation, even if they have not developed symptoms,” says Dr. Sabik.