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Heart, Blood and Circulatory System :
Mitral Valve Stenosis And Mitral Valve Replacement

Mitral valve stenosis happens when the mitral valve – which regulates blood flow between the upper and lower chambers in the left side of the heart – is narrowed. Mitral valve stenosis can lead eventually to heart failure or heart infections or stroke. Mitral valve replacement, an open heart surgery, is performed when the mitral valve is too damaged to be repaired.

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1. Who performs the Mitral Valve Surgery?

A cardiac or cardiothoracic surgeon does Mitral Valve surgery. It is not easy to perform the procedure without the proper tools and facility. Any experienced cardiac surgeon should be able to perform the surgery ensuring good outcome.

2. What is the difference between a cardiologist and a cardio-thoracic surgeon? Who usually performs an angiogram procedure?

Cardiologists are physicians who specialize in diagnosing and treating heart diseases. A cardiac surgeon does heart surgeries. A thoracic surgeon does surgery of the chest, other than the heart. These two are separate specialties. A cardiothoracic surgeon can do both the heart and chest surgeries.

3. What is mitral valve prolapse?

Mitral Valve Prolapse (MVP) is the most common valve defect. It is caused by myxomatous degeneration where the valve leaflets and its subvalvular apparatus are affected. The leaflets and chordae are thick and enlarged. They flop back into the left atrium. This condition is also called “Barlow’s Syndrome” or “Click Murmur Syndrome”. About 5-10% of the people in the world are affected by this condition.

Mitral Valve Prolapse can be hereditary. Characteristics of these family members are tall, slender, straight backs and long arms. Women in the age of 20-30 commonly present with MVP, but it is not uncommon in men.

An Echocardiogram can confirm Mitral Valve Prolapse. Most people are unaware that they have MVP because most of them are asymptomatic. Only when a valve causes moderate to severe regurgitation, surgery is indicated.

4. Why should I take antibiotics before dental or surgical procedures after mitral valve replacement?

During dental or surgical procedures there is a risk of infection. Bacteria can enter the blood stream and infect the tissues surrounding the valve. Infection of the valves is called “Infective Endocarditis”. This is a serious condition that can be prevented by simply taking the prescribed antibiotics before the procedure.

5. When will I need a reoperation?

During your regular follow-ups, echocardiograms will be done to assess your prosthetic valve function. Mechanical valves lasts a lifetime and it is highly unlikely that you will need a re-operation in this case. Tissue valves lasts up to 15 years. Here, there is a chance that your valve is worn out and you need a different one. Before your first mitral valve replacement, your surgeon will discuss about the choices of prosthetic valves. He will also take into account your age, type of disease, your other health conditions, etc. to make a decision about the suitable valve for you.

Even after 10 years 95% of the patients do not require a redo operation.

Rarely a valve failure can occur, causing sudden symptoms like increased shortness of breath even at rest or fluid accumulation in your hands and feet. This requires immediate medication and probably an immediate surgery to replace the valve.

Another uncommon reason for replacing the artificial mitral valve is Infective endocarditis. This is due to infection of the tissues surrounding the prosthetic valve.

6. What are the side effects of anti-coagulants?

Before someone starts on anticoagulants, a physician should cross check the list of medications, including “over the counter” pills. Pregnant women should not take them as they can cause side effects in the babies. During breast-feeding, some of these medications can cause unwanted effects to the baby. Warfarin is not known to cause any problems.

The most common side effect that is associated with the anti-coagulants is bleeding. Any unusual bleeding or bruising should be notified to the doctor immediately. Any falls or injuries should be promptly checked to rule out internal bleeding. Gum bleeding, black stools, eye bleeding, nose bleeding, red spots on the skin, heavy oozing of blood from minor cuts, confusion, constipation, diarrhea, joint swelling, blood in urine or vomit, nausea, weakness, etc can be due to too much thinning of blood. Some of the less common side effects are rashes, itching, low back pain, cough, blue toes, dark urine, stomach cramps, bloating etc.

7. What should be my INR value if on these drugs?

A normal INR value for someone who is not on anticoagulants will be approximately between 0.8 and 1.2. INR increases when the blood becomes thinner. There is a therapeutic range of INR, which is mostly the target range for all patients. It is most likely between 2.0 –3.0. Very rarely will the target range be more than 3.0. Desired value can also vary depending on the patients’ diseases and conditions. This can happen if the patient experiences a second clot formation even when he/she is on blood thinners. INR values also determine the dosage of the anticoagulants.

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