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What is a mitral valve?

The mitral valve, one of the heart’s four vital valves, controls blood flow from the left atrium — one of the heart’s four chambers — to the left ventricle, the heart’s main pumping chamber. The valve sits between those two chambers, and it has two leaflets (also known as flaps or cusps) that control blood flow by opening and closing.

What is the mitral valve’s role in circulation?

The mitral valve opens when the left ventricle relaxes, letting blood from the left atrium fill the decompressed left ventricle. Pressure from the left ventricle contracting prompts the mitral valve to close. When the mitral valve is closed, blood is prevented from leaking into the left atrium.

What is mitral valve disease?

Mitral valve disease disrupts the flow of oxygen-rich blood through those chambers and, in turn, affects the rest of the body. It can cause fatigue, shortness of breath, and potentially heart failure. Many of our patients are born with congenital mitral valve disease, which can manifest as a unicuspid (having only one valve flap instead of two) condition. Other patients develop mitral valve disease after birth.

Mitral valve disease can present in one of three ways:

  • Mitral valve prolapse happens when the valve flaps don’t close smoothly, and they can collapse backward into the atrium. They might leak, causing regurgitation.
  • Mitral valve regurgitation is when the mitral valve doesn’t close effectively, allowing blood to leak back into the left atrium.
  • Mitral valve stenosis is when there is a narrowing or tightening of the mitral valve, making it hard for blood to move through it. This can cause a backup of blood to accumulate in the lungs. It is possible to have both valve stenosis and regurgitation.
  • Congenital mitral stenosis is a complex congenital heart defect (CHD) that affects the mitral valve’s function. It lessens blood flow into the left ventricle.
  • Rheumatic mitral valve disease is caused by inflammation brought on by rheumatic fever. It can damage the mitral valve, potentially preventing the valve’s leaflets to not close properly and causing the regurgitation of blood.

The disease and its presentations can also be associated with:

Mitral Valve Disease | Diagnosis & Treatments

How we approach treatment for mitral valve disease

The Congenital Heart Valve Program at Boston Children’s specializes in the care and treatment of mitral valve disease. The disease can present in complex and unique ways. Adding to that complexity, many children have already had surgery and are left with residual mitral regurgitation and stenosis, or other problems. Our team carefully considers two primary approaches when treating mitral valve disease: mitral valve repair and mitral valve replacement. The decision depends on the individual case, taking into account the patient’s condition, the severity of the disease, their heart anatomy, and overall health.

We have the expertise to develop the most appropriate individualized care plan for your child. Using innovative three-dimensional modeling that incorporates two- and three-dimensional cardiac echocardiography, CT scans, and cardiac magnetic resonance imaging (MRI), we can see every aspect of a patient’s mitral valve disease and their heart anatomy before surgery. These perspectives allow us to determine the best surgical approach as we strive to preserve native tissue.

Clinicians gather around screen to see heart imagery

Learn how 3D modeling has transformed the planning of surgery by showing details of a patient’s heart.

Mitral valve repair

Our team believes it is best to repair a diseased mitral valve than replace it with a bioprosthetic (cow or pig) or mechanical valve. Over the past decade, we have made tremendous strides in improving our valve repair techniques, including leaflet-based procedures and chordal procedures. This includes using new and proven catheter techniques that enhance the function of heart valves that were previously thought to be untreatable. Through research and clinical trials, we continue to develop innovative solutions to repair mitral valves in a way that will keep the other parts of the heart strong and healthy.

Mitral valve replacement

When efforts to repair a mitral valve have been exhausted, we then determine the best approach to replacing the diseased valve. Mechanical replacement valves are durable but require a patient to take anticoagulation medication for the rest of their lives. Bioprosthetic replacement valves do not require lifelong anticoagulation, but they may have a limited lifespan and thus require a patient to have more replacement procedures. Also, small prosthetic valves are limited in availability, which means young patients may need more interventions as they grow.

Fetal and infant cardiac intervention for mitral valve disease

We work closely with the Fetal Cardiology Program to detect and diagnose mitral valve disease and any CHD in the fetal stage. Thanks to advanced diagnostic imaging, we can pinpoint the disease and potentially intervene before birth with specialized in utero treatment. We are at the forefront of fetal cardiac care and have performed many interventions.

Some young patients with mitral valve stenosis may benefit from a catheter-based procedure called mitral valve balloon dilation. Our cardiologists and surgeons evaluate how a patient’s heart would respond to this procedure instead of surgery.

Mitral Valve Disease | Programs & Services