Most people who have mitral valve prolapse (MVP) don't need treatment because they don't have symptoms and complications.
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, if necessary
Medicines called beta blockers may be used to treat palpitations and chest discomfort in people who have little or no mitral valve backflow.
If you have significant backflow and symptoms, your doctor may prescribe:
- Vasodilators to widen your blood vessels and reduce your heart's workload. 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 warfarin (Coumadin®), dabigatran, heparin, and aspirin.
Surgery is done only if the mitral 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 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, you may have heart damage that can't be fixed.
Traditionally, heart surgeons repair or replace a mitral valve by making an incision (cut) in the breastbone and exposing the heart.
A small but growing number of surgeons are using another approach that involves one or more small cuts through the side of the chest wall. This results in less cutting, reduced blood loss, and a shorter hospital stay. However, not all hospitals offer this method.
Valve Repair and Valve Replacement
In mitral valve surgery, the valve is repaired or replaced. Valve repair is preferred when possible. Repair is less likely than replacement to weaken the heart. Repair also lowers the risk of infection and decreases the need for lifelong use of blood-thinning medicines.
If repair isn't an option, the valve can be replaced. Mechanical and biological valves are used 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 over time and often last only about 10 years.
After surgery, you'll likely stay in the hospital's intensive care unit for 2 to 3 days. Overall, most people who have mitral valve surgery 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. These procedures can allow bacteria to enter your bloodstream. Antibiotics can help prevent IE, a serious heart valve infection. Discuss with your doctor whether you need to take antibiotics before such procedures.
Researchers are testing whether they can repair leaky mitral valves using a catheter (tube) inserted through a large blood vessel.
This approach is less invasive and can prevent a patient from having open-heart surgery. However, only a few medical centers are doing this type of procedure. Large studies haven't yet shown that this new approach is better than traditional approaches.