Best to Fix Your Heart Valve Problem Now Rather Than Later
Surgical intervention for mitral valve disease can help, and knowing exactly when to intervene is important. Experience shows that acting earlier results in better outcomes for patients.
Contributor: Marc Gillinov, MD
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Your heart valves regulate blood flow and prevent blood from backing up in the heart or flowing in the wrong direction.
Mitral valve disease is a disorder of the valve that separates the upper chamber of the heart from the lower chamber of the heart. Over the years, mitral valve disease can cause heart damage.
Surgical intervention can help, and knowing exactly when to intervene is important. Experience shows that acting earlier results in better outcomes for patients.
The more we learn about valvular heart disease and mitral valve surgery, the better we find it is to correct problems early rather than late in the disease. In late stages of mitral valve disease, the heart weakens and starts to dilate.
Elevated pressure in the lungs, a condition called pulmonary hypertension, also can occur. Atrial fibrillation, when the upper chambers of the heart beat fast or erratically, is another potentially serious development.
We want to act before these situations arise — before problems develop that we cannot always correct completely.
The best time to act is before consequences occur. We call this time the golden moment. This is the optimal period when the valve lesion is severe but before the you suffer damage as a result of the defect.
From experience, we know that outcomes are better with earlier intervention. Patients do better in and out of the hospital and long-term survival rates are better. The reason is that heart and system damage has not yet occurred so recovery is easier and better.
On the other hand, it is important not to intervene too early and to understand that some patients never will require surgery. We base our decision to intervene on what symptoms and signs that we find.
Symptoms include shortness of breath, fatigue and decreased exercise tolerance. These are clear indications that damage has occurred and that intervention is needed.
We also look for signs using tests such as echocardiograms that show a dilated heart — which indicates that it has become weak — and enlargement of the left atrium.
Other signs that can occur before any symptoms develop are atrial fibrillation and pulmonary hypertension.
We want to act when we find signs of mitral valve disease, even if a patient has no symptoms or doesn’t feel any physical impairment. This is really true for all types of valve disease. We want to act before irreversible consequences occur.
It’s also important to decide if a patient needs surgery or if that patient will do better with medical treatment.
We base our decisions on clinical observations. An observational study published in JAMA shows that doctors do a good job in matching patients with appropriate care.
We observe signs and symptoms in each patient and look at all options. We don’t operate on all patients. This is important because we can get good results from medical treatment as well as surgery. For each patient we look at current status and history to determine the best possible course of action.