Transcription:
Mitral Valve Disease

Prakash Chandran: Leaking in the mitral valve of the heart may cause severe implications for our wellbeing. It's important to know the early symptoms of a leakage and learn how you can be proactive in addressing your heart health. We're going to talk about it today with Dr. Dan Meyer, Chief of Heart Transplantation and Mechanical Circulatory Support and a Cardiac Surgeon at Baylor University Medical Center. This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas and in Fort Worth. I'm Prakash Chandran. So first of all, Dr. Meyer, great to have you here today. Can you start by describing the main function of the mitral valve?

Dr. Meyer: So, you know, there's four main valves of the heart and the mitral valve is on the left side. The left side is the main pumping chamber of the heart. And so when the blood goes to the lungs to get oxygen and comes back to the heart, it goes into the left atrium and then down into the left ventricle where it gets pushed to the rest of the body. And so that mitral valve is between the left atrium and the left ventricle. And so when the heart beats and ejects the blood to the rest of your body, that's when that mitral valve closes. And the problem is everything is fine until that mitral valve is diseased and leaks. So then when the heart beats in a leaky mitral valve, the blood goes backwards to the lungs and the patients have these symptoms of shortness of breath and just difficulty walking, fatigue and a lot of different problems like that. So that's the issue with the mitral valve.

Host: What exactly causes leakage in the mitral valve in the first place, and are there different types of leakages?

Dr. Meyer: We look at like three main types, and the type that we deal with most often is what's called degenerative mitral valve disease. It's when, as we all get older, the valve can start to stretch out and get floppy. There's two parts to the mitral valve, two leaflets, and when the heart beats, they touch each other and that's how the valve closes. And there's these kinds of strings or cords that attach to the valve and then also attached to the heart. And so when those get stretched out, then again with age then when the heartbeats, the valves can't come together because everything's either stretched out or occasionally these cords can fracture and break, and then there's a lot of leaking. So the degenerative aspect is one reason. The valves can, your mitral valve can get infected, not super common, but it can happen.

 

And you can get to, what's called a perforation in the valve. And again, when the valve closes, when the heart ejects the blood, when it beats, then that whole lets all this blood go backwards. So that's another way we can have problems. And then in the less common is rheumatic heart disease, but we still see a lot of that. And that's where like, when you're a young child, you get dramatic fever and that can affect the heart valves. And so that can also mean that the valve scarred down. And so those cords can get kind of scarred in. And so the leaflets, can't what we call co-op. They can't touch each other. So when the heart beats in the valve is supposed to close the leaflets, the two leaflets can't come together. And that leads to leaking of the valve.

Host: I see. And is this normally a genetic thing or is this caused by our diets? I know you said for the one disorder specifically, sometimes when you're young, you get a high fever that could potentially cause it, but what are some of the reasons why we get leaky valves in the first place?

Dr. Meyer: It's not typically genetic, that can happen, but most of it is just with this degenerative it's just with age that the tissue gets weak and then gets stretched out. And then that causes the issue. So it's not typically a genetic, it's more of a just wear and tear on the body.

Host: Got it. And, you know, you talked about some of the symptoms earlier, maybe cover them again and also talk about how one would know that they have mitral valve disease, if they don't have any symptoms?

Dr. Meyer: What typically can happen is when say you go in for a physical and your physician says, Hey, did you know you have a heart murmur? And so then the patient says, no, I feel fine. And then they start to think about it. And they say, well, I guess I haven't been cutting the lawn anymore because I get kind of short of breath. So it's, the symptoms are from no symptoms and you just have a murmur. And sometimes that murmur may stay there and not cause any problems then forever, but it's something that would have to be followed or you start to get symptoms like fatigue, which is really common with mitral valve disease more significant symptoms of the shortness of breath with simple maneuvers walking or going upstairs. And then finally patients can get an irregular heartbeat just that reflecting that the heart's kind of working harder. And then it gets irritated and start to have abnormal heartbeat.

Host: And if you discover that you do have a mitral valve disease, what are the different treatment options that are available?

Dr. Meyer: I mean, the first thing though, is that often nothing needs to be done. And most commonly this is not in a, well, almost always, it's not an emergency, especially with the degenerative type of diseases that we see a lot of in the valve. So it's usually something that over time it's first managed medically. So your physician will give you some medicines that help the valve not to repair itself, but so the valve doesn't have to work as hard. So there are medicines that we use for that. And then over time, you know, there could be, you know, as your symptoms get more severe, that's when we start to talk about surgery.

Host: Okay. And so what percentage of people actually need to go through surgery? It sounds like a very small set. Is that correct?

Dr. Meyer: Yeah, that's correct. Although, you know, the ones that we see are being a surgeon, those are the ones that we see. So but in terms of people that have mitral valve disease, you know, probably the majority of them don't need anything. At least initially, but over time, the key is that when you have any intervention, like even if it's surgery or nowadays, a lot of these things can be done, you know, with catheters and not surgery, but whatever the issue is, the key for people to know is you want to stay on top of this cause you don't want to let that heart muscle work so hard that it gets weak. Cause all the risk of like for heart surgery, the risk comes in when the heart is weak. If your heart has normal, we call function, the muscle is normal. Your risk is it's never a 0%, but it's close. So, but when your heart gets weak, that's when the risk of surgery goes up. So even though most people don't need anything done, they do need to be followed. So, when their symptoms start to get worse, they can get referred for surgery.

Host: Okay. Got it. And so for the people that do go in for surgery, can you talk a little bit about what the recovery process is like?

Dr. Meyer: What we'd like to do is to repair the valve and that's the beauty of the mitral valve. It's one of the few valves that can be repaired. And so over the years, a lot of people have refined the techniques. And so repairing the valves are key. And then how we repair it. If we use a standard incision or nowadays, a lot of our patients are done using what we call minimally invasive or robotic techniques. So there's a lot of ways to fix the valve and that reflects how long you're in the hospital basically. But usually, most people everyone's in the hospital like overnight in the intensive care unit, no matter how we do it. And then they usually, after the first day go to a regular room where they're just monitored. So most of the time in the hospital, three or four days, basically, no matter how we do this.

Host: And what about the prep work leading up to the surgery itself? Is there anything that patients need to do beforehand?

Dr. Meyer: No. I mean, we will have known their disease, the extent of their mitral valve disease by what's called an echocardiogram. And so that'll tell us basically exactly what we're going to do at the time of the surgery. So we know we will be able to talk to the patient ahead of time saying almost for, you know, verbatim what steps we're going to do, how to repair that valve. If it's going to be a repair or if we're going to replace it we'll know that as well, usually by the preoperative echocardiogram. And sometimes based on their age, if they're over 40 or 45, they'll get, what's called a cardiac catheterization. And that's where we look at their arteries in the heart because you don't want to have a valve surgery and go through all this. And then two years later say, Oh, I have chest pain. And they look, and you have a little blockage that they have to do a bypass surgery. So we do, that's part of, kind of the preoperative evaluation. And then depending if they have other issues, if they have any breathing issues, sometimes we have to look at their lung function. But mostly it's just those basic cardiac studies.

Host: Let's say someone is listening to this. And they're saying, you know, I feel like I may have shortness of breath and some fatigue. And this is something that I might want to consider following. What do you recommend people do to just start monitoring this? And when do you recommend they do it?

Dr. Meyer: Well, the key is, you know, working with your primary care physician and if you have a cardiologist, so you can be monitored closely because again, what you don't want to do is let that heart get weak and it takes a while. So it's not that it's going to happen overnight, but that's what you don't want to have. Cause you don't want to go into any procedure that you could have been super low risk and have it now be a bigger issue. So that's the one thing is that close follow-up with your primary care and your cardiologist. And then when it is time to have surgery or consider surgery, you know, find a place that does a lot of these procedures because you want to, when you talk to your surgeon, you want to make sure that they have done a lot of mitral valve surgery and they should be able to tell you, you know, within 95% accuracy, if it's a valve that they're going to repair or replace. Because for at least for the degenerative type of valve disease, you really, these days want to have a repair. And so you want to go to a place that has the experience, the expertise and the team that can offer that. And that's what we do at Baylor.

Host: That's really good advice. Just as we close here, you know, after seeing so many different patients and performing so many different types of surgeries, is there one piece of advice that you'd like to share with our listeners that you wish that they knew before they came to see you?

Dr. Meyer: We are research, make sure you're comfortable with the facility and your surgeon surgical team by, you know, by speaking with your surgeon and just be in the right frame of mind going into the surgery because it's no matter what we do. It's a whole lot for the patient afterwards. They have to be mentally prepared to work hard afterwards, in cardiac rehab, walking, getting out of bed the day, sometimes a day of surgery. So I think just being prepared mentally for feeling better, but it's a little bit of a Trek to get there.

Host: Well, Dr. Meyer, I truly appreciate your time today. This has been hugely insightful and I really appreciate it. That's Dr. Dan Meyer, chief of heart transplantation and mechanical circulatory support and a cardiac surgeon at Baylor University Medical Center. Thanks for checking out this episode of Heart Speak. To find a cardiac surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital, Dallas and Baylor University Medical Center. Call 844-BSW-DOCS. Once again, that's 844-BSW-DOCS, and ask for a cardiac surgeon with expertise in mitral valve surgery. To learn more about the cardiac surgery program, visit Baylorhearthospital.com or download the Baylor Heart Center App on your Apple device. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.