Mitral Valve: diagnosis and heart surgery for the patient

Heart health depends on the signals the body sends, sometimes silently, other times more clearly. Among the most common heart diseases, those affecting the mitral valve can progress slowly, initially presenting with mild symptoms that are easy to underestimate.

«The most common symptoms associated with mitral valve disease are, first of all, dyspnea, meaning shortness of breath. At first it occurs during exertion, then even at rest, eventually leading to what is called orthopnea, or shortness of breath while lying down. Patients may also experience asthenia, meaning fatigue. Sometimes, the warning sign can be the onset of atrial fibrillation», explains Cristina Barbero, cardiac surgeon at the Città della Salute e della Scienza hospital in Turin. «However, in a patient with severe mitral insufficiency, it is not always necessary to wait for these symptoms or for the first signs of heart failure before considering surgery. This is especially true in degenerative disease, which is the underlying mechanism behind the well-known mitral valve prolapse».

Repair or replacement of the Mitral Valve?

In mitral valve surgery, valve repair is increasingly preferred over valve replacement. «Repair has shown better outcomes in terms of operative mortality and complications, as well as long-term survival, when compared with valve replacement. Today, valve repair is the surgical procedure that a high-volume, highly experienced centre should be able to offer patients».

While choosing the surgical technique is important, the timing of diagnosis is equally crucial. «Untreated mitral valve insufficiency or stenosis over a long period can lead to dilation of the left ventricle, reduced contractile function of the ventricle itself, or enlargement of the atrium. All of this may result in complications such as atrial fibrillation or the development of pulmonary hypertension».

Barbero continues: «These changes in hemodynamic balance significantly increase the patient’s perioperative risk. This is why early and timely diagnosis can truly improve patient outcomes, both in terms of mortality and major perioperative complications».

Minimally invasive techniques and aesthetic impact

When saving a life, the priority remains the heart, but for those undergoing surgery, what remains visible on the skin also matters.

Although aesthetic considerations are not the main priority in these circumstances, they are becoming increasingly important.

«The surgical approach to mitral valve surgery has changed dramatically in recent years. Increasingly minimally invasive techniques have been introduced. Today, the gold standard for mitral valve surgery is mini-thoracotomy: a small incision of three to four centimeters in the chest wall that allows surgeons to reach the heart and the mitral valve – Barbero continues – This significantly reduces surgical stress for the patient, improves postoperative recovery, and offers better cosmetic results with less psychological impact».

The human side of cardiac surgery

Operating on the heart is a complex and deeply meaningful experience for a surgeon, not only professionally but also on a human level. Every decision, every action, every direction taken in the operating room can have direct consequences on the patient’s life and inevitably on the lives of their family members as well.

«It means having to balance the risks and benefits of every choice, not only by considering the heart disease itself, but by looking at the patient as a whole, weighing factors such as age, frailty, and comorbidities».Collaboration is especially essential when difficult decisions must be made.

«Teamwork is fundamental. Knowing you can rely on the support of anesthesiologists, cardiologists, nurses, and perfusionists. Only in this way can the best possible outcomes truly be achieved for the patient».