Dr. Ramchandani
Heart Surgeon

Dr. Ramchandani is experienced in mitral valve repair, which is at the forefront of valve surgery.

Mitral valve repair is an open-heart procedure that treats stenosis (narrowing) or regurgitation (leakage) of the mitral valve, which is located on the left side of the heart. When the mitral valve opens, it allows blood to flow into the heart's main pumping chamber (the left ventricle). It then closes to keep blood from leaking back into the lungs.

Surgery may be necessary when the valve does not open or close completely. A stenotic (narrow) valve does not let the blood easily into the heart, causing blood to "back up" and pressure to build up in the lungs. This makes it difficult for the heart to increase the amount of blood that it pumps with exercise, and may produce symptoms of shortness of breath - especially with activity.

Since some of the blood leaks backwards, the heart has to pump more blood with each contraction to push the same amount of blood forward. The heart can compensate for this for many months or years, provided that the leakage came on slowly and progressively. Eventually, the heart begins to fail, and patients show symptoms of shortness of breath or fatigue.

What causes mitral valve problems?

Most often, simple "wear and tear" may cause part of the valve mechanism to fail. This is called "degenerative disease". This may be related to advancing age, although many young people will have this condition as well. Other causes of mitral stenosis or regurgitation include Rheumatic fever, infection, and coronary artery disease.

Many mitral valves can be repaired, but if the valve is too damaged to permit repair, the valve must be replaced with a prosthetic (artificial) valve. Valves damaged by rheumatic disease must often be replaced.

In general terms, there are two types of artificial valves available - mechanical valves made entirely from metal and pyrolytic carbon - or biological valves- made from animal tissues. Each has advantages and disadvantages with respect to durability (how long they will last) and risk of blood clots forming on the valve. The choice of which type to use should be made by you and your doctor, taking the following into consideration:

• Your age
• Other medical conditions
• Your preferences with regard to medications and the risk of reoperation
• Your lifestyle

There are a variety of biological alternatives for mitral valve replacement. Most are made from pig aortic valves. Their key advantage is that they have a reduced risk of blood clots forming on the valve itself causing valve dysfunction or stroke. The key disadvantage of biological or tissue valves is that they have more limited durability as compared with mechanical valves.

They will wear out given enough time. The rate at which they wear out, however, depends on the patient's age. A young boy might wear out such a valve in only a few years, while the same valve might last 10 years in a middle aged person, and even longer in a patient over the age of 70. Of course, as we grow older we expect that we will not need the valve for as many years as our life expectancy is less. The general consensus is that a tissue valve will not need to be replaced if used in a patient over the age of 70 years.

Biological Valve