Mitral valve disease represents a significant burden of cardiovascular disease globally, affecting millions of patients and requiring both medical management and surgical intervention in severe cases. The mitral valve, located between the left atrium and left ventricle, is the most commonly affected valve requiring surgical intervention. Livasa Hospital provides expert mitral valve surgery, with a strong emphasis on valve repair when feasible, which offers superior long-term outcomes compared to replacement.

Understanding Mitral Valve Disease

The mitral valve functions as a one-way gate, allowing blood to flow from the left atrium into the left ventricle during diastole while preventing backward flow during systole. Mitral disease manifests as two primary patterns:

Mitral Stenosis:

• Progressive narrowing of the mitral valve opening

• Impedes blood flow from atrium to ventricle

• Most commonly results from rheumatic fever sequelae

• Leads to left atrial enlargement and pulmonary congestion

Mitral Regurgitation:

• Incompetence of the valve allowing backward flow into the atrium

• Can result from leaflet prolapse, endocarditis, rheumatic disease, left ventricular dilatation or previous valve procedures

• Causes progressive left ventricular and atrial dilatation

Clinical Indications for Surgical Intervention

Mitral valve surgery is indicated for:

• Symptomatic severe mitral stenosis – Despite optimal medical therapy

• Asymptomatic severe mitral stenosis with markers of risk – Atrial fibrillation, pulmonary hypertension, left atrial thrombus

• Symptomatic severe mitral regurgitation – Progressive dyspnoea or left ventricular dysfunction

• Asymptomatic severe mitral regurgitation – With reduced ejection fraction or significant ventricular dilatation

• Prosthetic mitral valve dysfunction – Stenosis, regurgitation or thrombosis

• Infective endocarditis with mitral destruction – Causing haemodynamic compromise

• Moderate mitral disease – When undergoing concurrent cardiac surgery

Mitral Valve Repair – Preferred Approach

Whenever technically feasible, mitral valve repair is strongly preferred because:

• Preserves native valve anatomy and function

• Avoids prosthesis-related complications

• Superior long-term durability compared to replacement

• Lower incidence of infective endocarditis

• Maintains physiological valve function

• Eliminates need for lifelong anticoagulation (with mechanical valves)

Repair techniques include:

• Leaflet resection for prolapse or vegetations

• Commissurotomy for stenotic valves

• Chordal replacement or transfer

• Papillary muscle repositioning

• Annuloplasty for annular dilatation

Success rates for mitral repair exceed 90 percent in appropriately selected patients.

Mitral Valve Replacement – When Necessary

Valve replacement becomes necessary when:

• Damage is too extensive for repair

• Stenosis is irreversible

• Previous repair has failed

Prosthesis options include:

Pre-Operative Evaluation

Comprehensive assessment includes:

• Detailed transoesophageal echocardiography defining valve anatomy

• 3D echocardiographic reconstruction for operative planning

• Coronary angiography to identify concurrent CAD

• Assessment of ventricular function and dimensions

• Pulmonary artery pressure assessment

• Presence of atrial fibrillation

• Left atrial thrombus exclusion

• Evaluation of other cardiac valves

The Mitral Valve Surgical Procedure

Steps include:

1. Median sternotomy – Full-length chest incision

2. Cardiopulmonary bypass – Institution of heart-lung machine support

3. Left atrial exposure – Various approaches to access the mitral valve

4. Valve assessment – Intraoperative inspection to confirm reparability

5. Valve repair or replacement – Depending on findings

6. Valve testing – Assessment of competency and function

7. Angioplasty if needed – Annular reinforcement to prevent future dilatation

8. Weaning from bypass – Return to normal circulation

9. Closure – Multi-layer chest closure

Operative time typically ranges from 2–4 hours depending on complexity.

Post-Operative Management

Hospital recovery:

• ICU monitoring for 24–48 hours

• Progressive weaning from mechanical ventilation

• Hospital discharge typically on postoperative day 5–7

Home recovery:

• Restricted arm activities for 4–6 weeks

• Progressive activity escalation

• Cardiac rehabilitation participation

Long-term follow-up:

• Regular echocardiographic surveillance

• Anticoagulation if mechanical valve (INR 2–3)

• Antibiotic endocarditis prophylaxis

• Activity recommendations

Expected Outcomes

Modern mitral valve surgery achieves:

• Operative mortality <2% in most patients

• 90%+ successful repair rate in appropriate candidates

• Excellent long-term functional status

• Reduced incidence of atrial fibrillation post-repair

• Improved exercise capacity

Why Choose Livasa Hospital?

• Experienced mitral valve surgeons with high repair success rates

• Advanced echocardiographic planning capabilities

• State-of-the-art operating facilities

• Comprehensive post-operative care

• Long-term valve surveillance programs

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency)
Website: www.livasahospitals.com

Call +91-80788 80788 to schedule a mitral valve disease consultation at Livasa Hospital.