Mitral valve prolapse is the most common valve abnormality of the heart, affecting up to 10 percent of the population. Most patients with mitral valve prolapse have no symptoms or very mild symptoms and require no treatment.

The mitral valve is a one-way valve directing blood from the left atrium — the upper chamber of the heart — to the left ventricle, the main pumping chamber of the heart. The mitral valve, made up of two “sail-like” structures called leaflets, is supposed to close when the heart beats. This allows blood to leave the left ventricle in the proper direction to the body. Mitral valve prolapse is a condition in which one or both portions of the valve are “loose” so that the valve does not close completely when the heart contracts. This allows the blood to go backwards through the heart, leading to inefficient heart function and possible symptoms.

Most patients with mitral valve prolapse have no symptoms because only a small amount of blood leaks through the abnormal valve. However, when the amount of leakage through the valve becomes excessive, symptoms develop. These include chest pain, fatigue, shortness of breath, dizziness or fainting spells. Other heart conditions also can cause a leaky mitral valve, the most common of which is myocardial infarction, or heart attack. If a heart attack occurs in the portion of the heart where the mitral valve is attached, then the valve becomes dysfunctional and starts to leak. When significant valve leakage is left untreated, the heart gets weaker, enlarges and congestive heart failure sets in.

When symptoms of heart failure develop (shortness of breath, leg swelling, fatigue) or the heart begins to enlarge or weaken, patients are advised to have an operation to treat the leaky mitral valve. Traditionally, this treatment involved an operation to remove the leaky heart valve and replace it with an artificial valve made of animal tissue (pig or cow) or a mechanical/metallic valve. Mitral valve replacement is one of the first open-heart operations developed and has been performed successfully since the 1960s.

Mitral valve repair is a newer technique used to treat leaking mitral valves whether caused by mitral valve prolapse, heart attacks or other conditions. In mitral valve repair, the surgeon preserves the patient’s own mitral valve tissue and uses a variety of techniques to stop the leakage of blood through the valve. The operation is a more complex and difficult procedure to perform than replacing the valve. It requires additional expertise and training. However, mitral valve repair has many advantages over replacement of the valve. These include better heart function after surgery, fewer risks of future strokes or valve infections, and a lower mortality rate.

Surgeons at Washington University have extensive experience in mitral valve repair and perform many of these operations at both Christian Hospital Northeast and Barnes-Jewish Hospital. In the last three years, more than 350 mitral valve repair operations have been performed at both institutions with excellent outcomes.

More than 80 percent of patients with mitral valve leaks treated by Washington University cardiac surgeons can have a successful valve repair instead of replacement.

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Washington University physicians are the medical staff of
Barnes-Jewish Hospital and St. Louis Children's Hospital