Mitral valve insufficiency (Mitral valve incompetence)
Mitral valve insufficiency or a leaking mitral valve occurs during left ventricular contraction. When the left ventricle contracts blood is supposed to move in one direction through the aortic valve to the aorta. However, when the mitral valve is leaking, blood will flow backward to the left atrium during ventricular contraction. As a result the blood volume and the pressure inside the left atrium increases which in turn leads to increased pressure in the pulmonary veins ( Their Function is to bring blood from the lungs to the heart). As a result of this incompetence, the left atrium will gradually enlarge to become able to hold the excess amount of leaking blood. An enlarged atrium is potentially harmful. The atrium will start to lose its ability to beat regularly and its rhythm is disturbed resulting in atrial fibrillation. As a result of this irregular beating, blood circulation is affected inside the atrium and blood clots may form. A fresh blood clot can move down to the ventricle and eventually pumped to the body organs such as the brain leading to stroke.
When mitral valve insufficiency become severe, fluid will start accumulating in the lungs (lung congestion). Also the amount of blood pumped to the body is reduced and with time the left ventricular muscle is weakened. The net result will be development of heart failure.
Causes:
- Rheumatic fever: this is the most common cause in developing countries but rare in USA and Europe. Rheumatic fever is an illness that occurs in children in the age group of 5-15 years. The disease is caused by poorly treated throat infections caused by streptococcal bacteria.
- Myocardial infarction or Heart Attack: Most common cause in USA and Europe. A heart attack will destroy the papillary muscles which are responsible for the opening and closing function of the mitral valve.
- Myxomatous degeneration: it is a genetic disorder that affect the connective (binding) tissues of the mitral valve. The valve weakens with time and loses its ability to close properly.
Symptoms Of Mitral Valve Insufficiency:
In mild cases , the patient usually has no symptoms. As the disease progresses, the patient will start experiencing palpitations and shortness of breath with effort . When heart failure develops , cough , shortness of breath at rest, coughing blood and swelling of both legs will occur.
Diagnosis:
The first step of diagnosis is a thorough examination by the physician. With a stethoscope , the doctor will listen to your heart and an abnormal sound or a heart murmur characteristic of mitral incompetence is usually heard. To confirm the diagnosis, the doctor will order an echocardiogram which is simply an ultrasound of the heart. Echocardiogram will give a detailed picture of the heart and its valves. An electrocardiogram will be be ordered to check if the heart rhythm is still regular or not. Chest x-ray is another exam done to check the size of the heart and the condition of the lungs.
Treatment of Mitral Valve Insufficiency:
In mild cases routine follow up may be the only thing required to monitor the progress of the disease. Antibiotics may sometimes be prescribed before some dental and surgical procedures. Moderate mitral incompetence may be treated with some drugs such as angiotensin converting enzyme inhibitors, digoxin and diuretics. In case of sever mitral insufficiency, surgery will be the only solution. Decision to proceed to surgery will be based on the status of the left ventricle. Surgical intervention is a must before there is a permanent damage in the left ventricle.
Two Surgical options are available, either mitral valve repair or replacement. Valve repair should be the first priority when treating mitral valve insufficiency. A naturally repaired valve will function more properly than an artificial valve. Replacement will be done if the valve repair is difficult and the patient will have to take an anticoagulant for 3-6 month if a bioprosthesis ( pig tissue valve) is used and for life if a mechanical valve is used.
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Yasser Elnahas
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