2023-11-07 09:45:02
What is the mitral valve?
The heart has 4 valves which ensure sealing between its different compartments. “The mitral valve is located between the left atrium and the left ventricle. When the left ventricle contracts, the two leaflets that make up the mitral valve close to prevent blood from flowing back into the left atrium, where it comes from. explains Dr Hakim Benamer, president of the Coronary Atheroma and Interventional Cardiology Group of the French Society of Cardiology.
This valve is capable of withstanding very high pressures. But it also has these limits. That’s what we call mitral insufficiencya disease that affects 10% of people over 75 years old.
Four stages of mitral regurgitation
We speak of mitral insufficiency when the valve is no longer watertight: it no longer ensures its “anti-reflux” function. Cardiologists distinguish four stages:
In stage 1, the mitral leak is minimal.
At stage 2, it is average.
At stage 3, it is important.
At stage 4, it is massive: the seal between the atrium and the left ventricle is no longer ensured at all.
Mitral regurgitation: what are the risks in the absence of treatment?
Mitral regurgitation progresses slowly. “If it lasts too long, the left ventricle will eventually dilate which leads to heart failure,” explains Dr. Benamer.
The consequences are both cardiac and pulmonary. “If the heart pump is less efficient, the flow of blood entering the aorta is less good. Consequence: all your organs are less well perfused. You have difficulty making physical efforts, you are more tired. Second consequence: if the blood flows back into the left atrium, the pressure is reflected upstream at the level of the pulmonary capillaries. Blood then spreads into the pulmonary alveoli which can lead to acute lung edema. If we do not intervene quickly, this very serious pathology can kill the patient,” indicates the cardiologist.
Why is the mitral valve damaged?
To explain it, Dr. Benamer uses an image: “We must imagine the two leaflets of the mitral valve as two sails secured to pillars by ropes. One of these ropes can suddenly break without any real explanation. It can also happen that a pillar, which is in fact a muscle, ruptures, which sometimes happens after a heart attack. explains Dr. Benamer.
Other causes are possible:
An infection of the heart (endocarditis, rheumatic fever, etc.) can damage the valve, paving the way for mitral insufficiency.
The mitral valve tissue can also be damaged by a degenerative disease, Barlow’s disease.
Finally, it happens that the mitral valve no longer works because of a “coaptation disorder”. Clearly, the two leaflets of the valve are no longer facing each other, which allows blood to escape. “This coaptation disorder occurs when the left ventricle is too dilated, for example because of a heart rhythm disorder or following an ischemic pathology, a heart attack for example,” explains the cardiologist.
Mitral regurgitation: what are the symptoms?
In the early stage of mitral insufficiency, the patient does not feel anything special. On the other hand, when the disease progresses, abnormal shortness of breath occurs during exercise, then at rest. In extreme cases, acute lung edema may occur, a medical emergency.
Under these conditions, we better understand the need to detect and treat this mitral insufficiency as early as possible.
How is mitral leak diagnosed?
First, the doctor listens to the heart using his stethoscope. He can then perceive a « souffle » abnormal indicating a problem with a heart valve, but without identifying which one.
Secondly, a ultrasound of the hearttrans-thoracic, allows the damaged valve to be precisely identified.
To refine the diagnosis another ultrasound, trans-esophageal this time, is performed. Concretely, a probe is inserted into the throat up to the esophagus using a flexible tube. This probe will be positioned naturally behind the left atrium. Thus, the doctor can accurately visualize the reasons for mitral insufficiency.
How to treat mitral regurgitation?
Drug treatment is initiated to control heart failure. But only surgery can repair the mitral valve. During the operation, which takes place open-heart, several actions are possible. They consist of either sewing the valve back on or replacing it with one. mechanical valve or bioprosthesis. It is also possible to reconstruct the mitral “ring” when it is too dilated.
In some patients, this surgery is contraindicated. In this case, we use a different technique: installing clips. Comparable to clothespins, these clips allow you to attach the two leaflets of the mitral valve together. Depending on the case, one or two clips are necessary to reduce the leak. The procedure takes place under trans-esophageal ultrasound and lasts approximately two hours. The clips are introduced through the groin then taken up venously to the mitral valve. “In 2022, 1660 Mitraclips were installed. The patient can go home the next day. This intervention currently concerns a minority of patients with mitral insufficiency. observe le Dr Benamer.
Classic surgery requires major intervention and a stay in a cardiac rehabilitation center for several weeks. But the result is better than with clips, a technique currently reserved for the most fragile patients who would not be able to withstand open heart surgery.
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