Dr. Rania Habib (Host): The Centers for Disease Control and Prevention estimates about 2.5% of the U.S. population, or 7.5 million Americans, are living with mitral valve disease. Aging is a major contributing factor to mitral valve disease, so the number of individuals with the condition is expected to grow as the population ages. What is the mitral valve? How does it work? What causes mitral valve disease and what are the symptoms? How is the condition diagnosed and how is it treated?

The answers to these questions are in this episode of the HeartSpeak podcast. Thank you for joining us for HeartSpeak. The podcast from Baylor Scott & White Heart and Vascular Hospital in Dallas, Fort Worth in Waxahachie. I'm your host, Dr. Rania Habib.

Today, we will discuss mitral valve disease with Dr. Yash Chugh. Dr. Chugh is a structural and interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital, Dallas and Baylor University Medical Center, part of Baylor Scott & White Health. Welcome to the podcast, Dr. Chugh. We are very excited to delve into this topic.

Dr. Yashasvi Chugh: Thanks so much, Dr. Habib. It's always a pleasure to be here.

Host: Now, we know that you have done extensive training in Cardiology and we're really excited for your expertise today. So, let's begin very simple. We know that there are four valves in the heart. What is the mitral valve and what is its function?

Dr. Yashasvi Chugh: Sure, yeah. So, the mitral valve, is like you said, one of the four valves in the heart. And this valve is on the left side of the heart. It basically separates the left upper and the left lower chambers. The left upper chamber is sort of like a reservoir that receives good clean oxygenated blood from the lungs. And it gives it to the lower chamber, which then pumps it out to our body and our vital organs.

Host: So obviously, this is a very important valve. What are the different types of problems that can affect the mitral valve?

Dr. Yashasvi Chugh: Yeah, definitely. It's a very important valve. And, as you had said, you know, it's the most common valve to actually get diseased in our lifetime. This valve, like the heart, has to beat every single minute that you are alive. So, there's a lot of stress that this valve has to go through when it opens and closes. And sometimes that act of constantly opening and closing causes wear and tear and it can cause the valve to tear, sort of like the strings of a parachute can break.

And then, the first and most common condition we can have is called as mitral regurgitation or, in simplistic terms, a leaky mitral valve. That's the first sort of subset of problem we have. The second type of problem we can have again with aging is the mitral valve can get tight. Like many things in the body, when things get beat up or, worn down, calcium gets deposited on them and it prevents the valve from opening appropriately. And that's a condition called as mitral stenosis or a tight mitral valve. So, these are the two main problems that we see especially with our aging population.

Host: How is mitral valve disease diagnosed, Dr. Chugh?

Dr. Yashasvi Chugh: It all starts with a good physical examination. Your primary care physician who you meet on an annual basis, you know, there's a reason why they listen to you. They listen to your heart with a stethoscope. Often just having a murmur itself is a good first step, which is a trigger to more testing. And the easiest and the simplest way to test for a leaky or a tight mitral valve is by doing a echocardiogram, which is an ultrasound designed to look at the heart valve and the heart chambers.

Host: Now that we know a little bit about diagnosis, if a patient is diagnosed with mitral valve disease, what are the main symptoms that they typically have?

Dr. Yashasvi Chugh: Yeah, that's a great question. So, it's on a spectrum, actually. So, a lot of patients when they're diagnosed, they have no symptoms for many years. And once they do develop symptoms, they develop symptoms because the heart is not used to working with a leaky valve. And it's unusual for the heart to have to work so hard with a leaky or a tight valve. And oftentimes, the symptoms we experience could be shortness of breath being tired and not sure why, having swelling in our legs, having weight gain, basically a lot of symptoms that resemble congestive heart failure.

Host: Dr. Chugh, what are the main treatment options available for patients diagnosed with mitral valve disease?

Dr. Yashasvi Chugh: Yeah. So for mitral valve disease, you know, we really tailor treatment options depending on what kind of disease it is, how old the patient is, and, you know, how many comorbidities or coexisting problems the patients have. Treatment can vary from just trying medicines to allow the heart to get stronger and make you lose volume by making you pee out extra fluid. And treatment can also be open heart surgery where our surgeons are able to either repair the valve so it functions like it was designed to function, or sometimes a valve is so diseased, it cannot be repaired, so it has to be replaced. And another option we have that I specialize in is doing minimally invasive procedures with catheters through the groin for patients who are unable to have open heart surgery because they're older and frail and recovery for them could be tough.

Host: So, it sounds like it's a very varied spectrum of procedures going from medication to minimally invasive procedures. And then, worst case scenario might be open heart surgery. Is that correct?

Dr. Yashasvi Chugh: Yes, that is how we look at it, yes.

Host: Okay. Well, let's go into specific situations that patients might have that they'd be curious about. If a patient has mitral valve regurgitation, but no symptoms at all, do they need to get a procedure to fix the mitral valve?

Dr. Yashasvi Chugh: Yeah, that's a great question, and I think this is a very important sort of point of emphasis. So, I think patients who have something wrong with their mitral valve, for example, they've been born with a floppy mitral valve called as either a Barlow's valve or another term used is fibroelastic disease of the mitral valve.

These patients can, over time, because of this extra floppy mitral valve tissue, because of wear and tear, have their valves become leaky. I explain this to our patients as the strings of the parachute can break. So, the parachute may still work. But it's certainly not going to work as well as it was before. So, what we have learned over time is even without symptoms when you have a leaky valve, the heart over time is not going to be able to withstand working with this leaky valve. And we think repairing this leaky valve early on, even when you don't have symptoms, is probably the best thing for the patients. Because we really want to get you through a procedure when your risk is low, when you're healthy. When you start becoming short of breath, oftentimes your risk at that point for undergoing the procedure becomes higher and your chance of success also becomes lower. there's a lot of information out there that also shows that people with leaky valves that are not treated don't live as long with people who don't have leaky valves. So even though you don't have any symptoms, there are everlasting consequences of not having your leaky valve taken care of in a reasonable timeframe.

Host: That makes a lot of sense. It sounds like, you know, preventing those symptoms from even occurring is going to ensure that that patient has a longer life with less symptoms long term.

Dr. Yashasvi Chugh: That is correct. Yeah. That's how we look at it.

Host: Now, for patients who have symptoms and mitral valve regurgitation, could they just be treated with medications?

Dr. Yashasvi Chugh: Again, this sort of talks about how complex the mitral valve is. So, I will tell you that not all types of mitral valve are the same, and not all types of leaky valve are the same. There are different types of leaky valves, based on the etiology or based on the reason why someone's valve is leaky. So, there's some situations where we'll say, "Yes, your valve is leaky, but we can probably give you medicines to help the leakiness get better and see if we can help the heart get stronger." But I think there are more instances when we say the valve is leaky and we have tried medicines, but it probably won't work. So, I think it's time for us to go ahead and fix your valve. Again, we fixed the valve so that you feel well. You out of the hospital, you don't get sick in the future, and we give you a shot at living a relatively normal life. So yes, in short, medicines are great, but they're certainly not good alone without a definitive fix which would involve either repairing or replacing a diseased mitral valve.

Host: That makes a lot of sense. It's a good adjunct, but not necessarily just the sole treatment option.

Dr. Yashasvi Chugh: Yes, that's correct.

Host: What procedural options are available for young patients? And are there less invasive options for the opposite population, the elderly who might have more medical problems?

Dr. Yashasvi Chugh: Yes. So historically, mitral valve disease has been taken care of with surgery. And the goal for the surgeons is always to repair your valve, which means we use special rings, special stitches, cords to try and recreate the architecture of the mitral valve that you were born with the least amount of material that we can use. And we've learned that when we repair valves, people actually live a normal life expectancy. So, it's as if nothing changed the course of their life expectancy.

There are some situations where repairing the valve is not possible because it has a lot of disease. By disease, I mean it's thick, it's got a lot of calcium on it, maybe it got torn because of various disease processes. And in this situation, the surgeons may not be able to repair the valve. So in this situation, they have to take out the diseased valve and replace it with a tissue valve or a metal valve. So yes, these are the two options we have.

Now over time, over the last decade or so, we have a few devices now where we can use special clips to try and repair valves without having to subject someone to open heart surgery. Now, these procedures, which are catheter based, are usually reserved for older patients in whom the risk of open heart surgery is quite high. So in these patients, we're able to use clips to bring together the architecture of the leaky valve and reduce the leakiness there, which in turn will help them feel better, stay out of the hospital and live a problem-free life.

Host: That's fantastic. Now, I know that you mentioned for young patients, you do try to use surgical tissue to replace the valve. We know, however, with current research that surgical tissue valves usually only last about 10 to 15 years. Once they fail, are there any options apart from undergoing surgery again?

Dr. Yashasvi Chugh: Yeah, that's a great question. And, you know, this is something our field, we have labeled this as lifetime management. You come to us with a problem and we want to make sure that you understand based on your age, what is your solution going to be for the next 30 or 40 years that you're going to be around for. So in case you get a surgical repair where we use least amount of hardware to fix your valve, you usually don't need anything done in your lifetime. But in case that is not possible and in case you end up getting a valve replacement where the surgeon chooses to put in a tissue valve, which is made of cow or pig tissue, in that case, tissue valve, unfortunately doesn't last a lifetime. Tissue valves usually last 15 years. When the tissue valves do fail, we have options now where we can go through the groin and we can actually put a second valve inside that valve, sort of like a Russian doll effect. And the patients, again, can go home the next day. They avoid the need for having their chest open. So, there is certainly an option. This is a newer option and a newer technique that we are offering select patients.

Host: Wow. That technology sounds incredible.

Dr. Yashasvi Chugh: It certainly is.

Host: Dr. Chugh, you have provided us with a world of information about mitral valve disease. What is your final take home message for the public about mitral valve disease?

Dr. Yashasvi Chugh: Yeah. So, I think the most important thing is if you have mitral valve disease, and like I said, mitral regurgitation or leaky valve is the most common valve disease out there, don't be afraid. We have a lot of options for you. And more importantly, I think if you have no symptoms and you've just been diagnosed with mitral valve disease, I would urge you to seek expert care sooner than later, because that is really the only way that we can ensure you continue to have a healthy and normal life expectancy.

Host: Thank you so much for your time.

Dr. Yashasvi Chugh: My pleasure. Thanks again, Dr. Habib.

Host: That was Dr. Yash Chugh, a structural and interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital. For more information about mitral valve disease, diagnostic and treatment services at Baylor Scott & White Heart Vascular Hospital in Dallas, please call 214-820-3604. That's 214-820-3604. If you need a specialist in mitral valve disease, please call 1-844-600-2342 or check out bswhealth.com/heartdfw.

I'm your host, Dr. Rania Habib, wishing you well. Thanks for listening to HeartSpeak, the podcast from Baylor Scott & White Heart Vascular Hospital in Dallas, Fort Worth, and Waxahachie. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library to find topics of interest to you.

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