Ask the doctor: Surgery for mitral valve prolapse

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Ask the doctor: Surgery for mitral valve prolapse

Ask the doctor

Surgery for mitral valve prolapse?

Q. In a study I heard about, people who had leaky mitral valves but no symptoms benefited from an operation to fix the valve. Many of the people in the study had mitral valve prolapse, as I do, but my doctor says I don’t have a heart murmur. Would surgery help me?

A. The results of this study, which appeared in the March 3 New England Journal of Medicine, don’t really apply to you. The people in it had enough leakage across the mitral valve to cause a definite murmur.

The mitral valve sits between the two chambers on the left side of your heart, the left atrium and the left ventricle. When this valve doesn’t close properly, blood can flow backward, from the ventricle to the atrium. This backward flow is called regurgitation. When it is substantial, it can cause fatigue and breathlessness, and stress the left ventricle.

For people like you, who don’t have a murmur (and so have little leakage across the mitral valve), the risk of developing any problems is very low. In fact, you don’t even need antibiotics routinely before dental work.

It’s a different story for people with a fair amount of regurgitation at the mitral valve. Waiting until symptoms develop before fixing the mitral valve is risky because in the interim the left ventricle may weaken so much that it won’t regain normal function even after the faulty valve has been replaced.

The New England Journal of Medicine study suggests that a simple, painless echocardiogram can help identify people with mitral valve regurgitation who might benefit from surgery before they develop symptoms.

Even though you have minimal leakage across your mitral valve, make sure to keep in touch with your doctor. Let him or her listen to your heart every year or so to check for the development of a murmur, indicating mitral regurgitation. If that happens, routine echocardiograms to measure the amount of leakage through the valve and to see if your left ventricle is getting larger (a warning sign) would be useful.

— Thomas H. Lee, M.D. Editor in Chief, Harvard Heart Letter

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Last updated:	August 21, 2006

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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