How Is Mitral Valve Prolapse Treated?

Most people who have mitral valve prolapse (MVP) don't need treatment because they don't have complications and have few or no symptoms. Even people who do have symptoms may not need treatment.

The presence of symptoms doesn't always mean that the backflow of blood through the valve is significant.

People who have MVP and troublesome mitral valve backflow usually need treatment. MVP is treated with medicines, surgery, or both.

The goals of treating MVP include:

• Preventing infective endocarditis (IE), arrhythmias, and other complications
• Relieving symptoms
• Correcting the underlying mitral valve problem, when necessary

Medicines

Medicines called beta blockers have been used to treat symptoms such as palpitations (strong or rapid heartbeats) and chest discomfort in people who have MVP and little or no mitral valve backflow.

If you have MVP and significant backflow and symptoms, your doctor may prescribe:

• Vasodilators to widen your blood vessels and reduce the workload of your heart. Examples of vasodilators are isosorbide dinitrate and hydralazine.
• Digoxin to strengthen your heartbeat.
• Diuretics (water pills) to remove excess fluid in your lungs.
• Medicines such as flecainide and procainamide to regulate your heart rhythms.
• Blood-thinning medicines to reduce the risk of blood clots forming if you have atrial fibrillation. Examples of blood-thinning medicines include aspirin and warfarin.

Surgery

Surgery on the mitral valve is done only when the valve is very abnormal and blood is flowing back into the atrium. The main goal of surgery is to improve symptoms and reduce the risk of heart failure.

The timing of the surgery is very important. If it's done too early and your leaking valve is working fairly well, you may be put at needless risk from surgery. If it's done too late, heart damage may have already occurred that can't be fixed.

Surgical Approaches

Traditionally, mitral valve repair and replacement are done by making an incision (cut) in the breastbone and exposing the heart.

A small but growing number of heart surgeons are using another approach that uses one or more smaller cuts through the side of the chest wall. This results in less cutting, reduced blood loss, and a shorter hospital stay. However, this approach isn't yet available in all hospitals.

Valve Repair and Valve Replacement

In mitral valve surgery, the valve is repaired or replaced completely. Valve repair is preferred when possible. Repair is less likely to weaken the heart. It also lowers the risk of infection and decreases the need for lifelong use of blood-thinning medicines.

If repair isn't an option, then the valve can be replaced. Mechanical valves and biological valves are available as replacement valves.

Mechanical valves are man-made and can last a lifetime. People who have mechanical valves must take blood-thinning medicines for the rest of their lives.

Biological valves are taken from cows or pigs or made from human tissue. Many people who have biological valves don't need to take blood-thinning medicines for the rest of their lives. The major drawback of biological valves is that they weaken and often only last about 10 years.

After surgery, a patient usually stays in the intensive care unit in the hospital for 2 to 3 days. Overall, most people spend about 1 to 2 weeks in the hospital. Complete recovery takes a few weeks to several months, depending on your health before surgery.

If you've had valve repair or replacement, you may need antibiotics before dental work and surgery that can allow bacteria into the bloodstream. These medicines can help prevent IE, a serious heart valve infection. Discuss with your doctor whether you need to take antibiotics before such procedures.

Experimental Approaches

Some researchers are testing the repair of leaky valves using a catheter (tube) inserted through a large blood vessel.

Although this approach is less invasive and can prevent a patient from having open-heart surgery, it's only being done at a few medical centers. Large studies haven't yet shown that this new approach is better than traditional approaches.