Treatment of mitral valve prolapse

Author Ольга Кияница

2019-04-28

Relatively favorable course is observed with mitral valve prolapse. Many patients do not make any complaints, but this does not mean that the disease can not be dangerous. With the development of mitral regurgitation, the process can even reach heart failure, which is why it is important to undergo appropriate treatment in time.

Mitral valve prolapse (PMK) is an organic disease in which the mitral valve, located between the atrium and the ventricle on the left side, begins to bend toward the atrium.If such deflections are minor, a person may feel unchanged. If complications of mitral regurgitation occur, the patient’s condition may be markedly complicated.

Clinical manifestations among patients with mitral valve prolapse is 2.4%, as evidenced by the Framingham Heart Study (FHS).

In the absence of symptoms, the patient is not prescribed special treatment, in such cases it is sufficient to periodically visit the cardiologist. If deterioration is determined at the next monitoring, then possible treatment methods are considered.

Video: Mitral valve prolapse: heart disease, which is vital to recognize in time!

General principles of treatment of mitral valve prolapse

Treatment of mitral valve prolapse in most cases is not required. Most often, patients do not detect any changes in themselves, or they are so weak that monitoring during routine medical examinations is sufficient.

Even those who have mitral valve regurgitation and disavtonomy symptoms may need only an annual checkup by a cardiologist. However, this does not mean that mitral valve prolapse is an absolutely benign disease.

Complications of MVP with significant regurgitation may be amenable to treatment with two main treatment options - conservative treatment and surgery. The least invasive method is usually preferable, but the plan of action depends on the severity of the case and on whether the patient has other diseases that may increase the risk of developing life-threatening conditions. Sometimes drugs and surgery are combined to achieve the desired goal.

It is worth knowing that pregnancy can increase the severity of symptoms of MVP. In such cases, women should discuss with their doctors the need for any special treatment.

There are three strategies of exposure during treatment of mitral valve prolapse:

  1. Prevention of infections (endocarditis) and complications.
  2. Relieving symptoms and discomfort.
  3. Fix any physical underlying problem.

The figure shows: 1 - tricuspid valve; 2 - aortic valve; 3 - pulmonary valve; 4 - mitral valve; 5 - mitral valve prolapse.

Drugs used to treat mitral valve prolapse

Progression of MVP can occur against the background of other disorders, such as regurgitation, atrial fibrillation and congestive heart failure. In such cases, the use of a drug is required to reduce discomfort and achieve the desired result. Some of them are used for long-term treatment, in particular, combination drugs from the following pharmacological groups can be prescribed:

  • Beta-blockers - they help reduce the heart rate, eliminate arrhythmia and chest pain associated with PMK. The mechanism of their impact is based on the blocking of adrenaline (norepinephrine) and norepinephrine, with the result that the heart begins to work more freely. Drugs in this group also dilate blood vessels, facilitating blood flow.
  • Benzodiazepines - products from this group, such as Xanax, have a calming effect on the body. This can help reduce anxiety associated with PMK. Such anti-anxiety drugs are usually prescribed to patients with symptoms of disavtosomy or mitral valve prolapse.
  • Vasodilators are often prescription drugs. They dilate blood vessels so that blood can circulate better, so they can reduce the severity of mitral regurgitation. Vasodilators are most often prescribed for patients with chronic or acute regurgitation and an enlarged left ventricle.
  • Blood thinners (anticoagulants) - reduce blood clotting and the risk of complications. Patients with stroke, heart failure, or atrial fibrillation sometimes need these medications. A doctor may prescribe an over-the-counter medication, such as aspirin or something stronger, such as warfarin.
  • Cardiac glycosides - most commonly used digoxin, which is useful in the treatment of regurgitation with atrial fibrillation. It helps to minimize irregular beats, slowing the heart rate. It is also used to increase heart rate in patients with a weakened left ventricle, which allows it to pump blood more efficiently.
  • Diuretics - eliminate fluid retention (edema) in the legs and lungs, which can be a side effect / complication of mitral regurgitation. Fluid accumulation is known to cause ankle swelling, fatigue and shortness of breath. This can lead to respiratory failure.

For prophylaxis, antibiotics are most often used, which prevent infective endocarditis, a serious infection of the inner lining of the heart. Some patients with MVP (a small percentage - patients at high risk) should take antibacterial drugs as a precautionary measure against certain medical and dental procedures.

Indications for surgery for mitral valve prolapse

Surgery may be required when MVP causes severe regurgitation, symptoms or complications, while conservative effects are ineffective. Surgical treatment of mitral valve prolapse is always risky, so the decision to conduct it should not be made hastily.

It is important to remember that even without any symptoms, significant regurgitation can lead to heart failure. Therefore, the delay can lead to the fact that the heart will be too weak or damaged to withstand the operation and then the surgeons are forced to refuse such a patient.

Surgical treatment of mitral valve prolapse:

  • Invasive. In most cases, operations are performed on an open heart, while the surgeon gains access to the heart through the chest, namely the sternum. After such an intervention, a recovery time of several weeks to several months is necessary, depending on the state of human health, the physical reaction to the procedure, and other indicators.
  • Minimally invasive . Many surgeons now prefer advanced, less invasive treatment methods, as this reduces blood loss, recovery time, risks, and complications. There are several ways to perform minimally invasive surgery, but, depending on the hospital, this is not always possible.

Surgical treatment options for mitral valve prolapse:

  • Reconstruction - this option of exposure allows you to save the mitral valve, resulting in reduced risk of infection and weakening of the heart. This method of valve repair also allows patients not to take anticoagulants throughout their lives. Reconstructive surgery may involve shortening the chordal tendons, removing excess tissue from the mitral leaflets or accumulations of calcium, as well as repairing defects in the form of holes. This may also include the attachment of vertices to the mitral ring and the restoration or contraction of the ring. Sometimes they replace with a prosthetic ring.
  • Replacement - when valve reconstruction is not possible, surgeons use a biological valve or a mechanical valve to replace a damaged one.

Both types of artificial valves function like real ones. Each replacement has its advantages and disadvantages.

Valve Types:

  • Biological valves are typically made from animal tissue, such as pigs and cows. Sometimes human tissue is used, then they talk about the donor valve. With these valves, patients are less likely to need blood-thinning drugs and medications. However, over time, they may lose their properties, so in the future a second operation may be required.

It is worth knowing that the validity of biological valves is usually more than ten years.

  • Mechanical valves - they are made of durable, lightweight substances such as titanium, and usually serve for a long time. The disadvantage is that patients should take anticoagulants or thinners every day throughout life, so that blood clots do not form around or on the artificial valve itself. It is known that blood clots, which are essentially blood clots, can cause a stroke.

It is important to point out that mechanical valves are more susceptible to infection.

Whatever type of treatment for mitral valve prolapse would not be used in a particular case, with timely treatment, the general prognosis is good. Some patients have complications, but in most cases they are absent.

Alternative non-drug methods of treatment of mitral valve prolapse

There are a number of options for the natural treatment of damaged mitral valve, which can reduce the severity of PMK symptoms (or even completely eliminate them), which in turn reduces the risk of complications. Blood pressure monitoring and blood flow stimulation are two important goals of each solution. They are said to work best in tandem.

Alternative treatments for people living with this disease include:

  • Healthy food. Certain foods and stimulants that can alleviate the symptoms of mitral valve prolapse and prevent the development of complications should be avoided. In particular, the use of hydrated and edible salt (in moderation) can also be beneficial. People with PMH should try to maintain a balanced diet.
  • Exercise . An active lifestyle is usually encouraged by health professionals and can be important for the treatment of fatigue, palpitations, chest pain, dizziness and anxiety associated with PMH. Studies have shown that aerobic exercise is especially helpful.
  • Nutritional supplements — in particular, it is beneficial to use magnesium, l-carnitine, acetyl-l-carnitine, and coenzyme q10, which can alleviate symptoms. B vitamins (thiamine b1, niacin b3, pyridoxine b6 and inositol) can also reduce discomfort, along with natural remedies such as hops and valerian.
  • Cognitive therapy - people with PMH syndrome can benefit from psychotherapy. A good therapist can help a person understand the cause of his symptoms, and sometimes even determine the triggering factors. With his help, a treatment plan can be developed, aimed at changing the mental response to what is felt physically.
  • Relaxation . The benefits of relaxation are numerous. Activities such as yoga, tai-chi, meditation and massage can reduce blood pressure, slow the heartbeat and breathing rate, improve blood flow and reduce tension and pain. They also help reduce anxiety, depression, and stress.

Note: Although supplements and herbs can be helpful, sometimes side effects can occur when they are used, especially when combined with certain medications for mitral valve prolapse. Also, the exercises may not be suitable for all patients with this disease. In this regard, be sure to consult with your doctor before taking supplements or starting a new exercise program.

Video: Mitral valve prolapse: heart disease, which is vital to recognize in time!


Sources:

Mitral valve prolapse

https://ru.wikipedia.org/wiki/%D0%9F%D1%80%D0%BE%D0%BB%D0%B0%D0%BF%D1%81_%D0%BC%D0BB%D1 % 82% D1% 80% D0% B0% D0% BB% D1% 8C% D0% BD% D0% BE% D0% B3% D0% BE_% D0% BA% D0% BB% D0% B0% D0% BF % D0% B0% D0% BD% D0% B0

Evolution of Mitral Valve Prolapse: Insights From the Framingham Heart Study

https://www.ncbi.nlm.nih.gov/pubmed/27006478

Transcatheter prosthetic mitral valve

https://www.bhf.org.uk/research-projects/2016/11/18/08/26/developmentofanartificialmitralvalvefortranscatheterimplant


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