AMitral valve prolapse Mitral valve prolapse

Q In 2001, my doctor told me that I suffered from mitral-valve prolapse (MVP), and that this heart abnormality was behind the atrial fibrillation with which I had been diagnosed two years earlier. Despite the MVP diagnosis, I remained symptom-free, and I didn’t even have any side-effects from the warfarin I was taking for the atrial fibrillation. However, things have been sliding downhill over the past year. I now get tired very easily, whereas I used to be very active, and my heart literally ‘aches’.

I am still awaiting the results from the diagnostic tests – an oesophageal echocardiogram and coronary angiography – but my doctors believe surgery is inevitable to have my mitral valve either repaired or replaced.

Are there any alternatives to surgery? If there are none, what are the risks and drawbacks of this operation? I am 55 years old, and both my parents also suffered from cardiac problems – my father had a slow heartbeat and needed two pacemakers, while my mother died from a heart condition. – Malcolm Linchis, London

A MVP is a common heart condition in which the two flaps of tissue (mitral valves) controlling the flow of blood from the upper to the lower left heart chambers stop working properly. As a result, blood is ‘regurgitated’ back into the upper chamber, causing a ‘heart murmur’.

While the symptoms of MVP are usually benign, with the majority of those affected continuing to lead normal lives, about a quarter of cases worsen with age. Progressive deterioration of the valves leads to more severe regurgitation, with the blood not only pushed back into the upper chamber, but also into the lungs. Symptoms such as breathlessness, fatigue and chest pain become more pronounced, as you’ve experienced and, in the worst-case scenario, congestive heart failure can ensue.

To prevent reaching such a dangerous stage, doctors recommend repairing your mitral valve or replacing it with a prosthesis, depending on the amount of damage. This essentially means open-heart surgery, and the risks are as high as you would expect for such an invasive procedure.

It is important that you consider very carefully if the benefits from surgery will outweigh the risks of the procedure. Once you have the results of your echo and angiographic tests, make sure the doctor explains to you as clearly as possible the severity of your condition and whether you really do need the surgery. Do not allow your doctor to wave away your questions and decide for you. Also, ask if there are any alternatives to surgery (see box on right).

If you do decide to opt for surgery, there seems to be a slight disparity between the success of mitral-valve repair vs replacement. Those who have undergone repair rather than replacement appear to have a slightly better chance of survival, and are less likely to need further surgery (J Cardiovasc Surg [Torino], 1999; 40: 93-9).

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