Post mitral valve repair

[ocean12]

I had my mitral valve repaired over a year ago with an annuloplasty ring. My recent echo showed mild leaking (there was no leaking up until now) with tethered leaflets. What does this mean. The part about the leaflets makes me worry.  I did have both leaflets repaired during surgery.

Thanks

[ocean12]

The timeframe is 8 months apart between the echo that showed no leaking whatsoever and the echo that revealed mild leaking with tethered leaflets.

[ed34]

I would have to agree and that's what I had in my mind. I just asked for the time scale to see how quickly it has gone from no leak, through trivial, and into mild. If this is over a few weeks, then alarm bells would ring in my head. If we are looking at a year then I would probably put it down to normal. I would still want scans probably once a year to keep an eye on it though, I can imagine these things tend to stick in your mind.

[Smiley2000]

Hi there,

I had my mitral valve repair (open heart sternotomy) with annuluplasty ring - March 2008.  We moved to Australia a year ago and I had to go for extensive heart tests to get a Visa.  Still mitral valve incompetence but nothing that would put me back into heartfailure and no need for re-operation in future.

I can assure you that mild leakage is a good result after OHS.  Just make sure that you eat a heart healthy diet and keep your cholestorol in check so that you don't develop CAD or any other heart related disease.

Please let me know if you need further help and info.  You have found a great Community forum!

[ed34]

I can see there being 2 possibilities here. First is the heart remodelling after compensating to a deficient mitral valve. Second is maybe a new problem, with the heart enlarging. I assume that your latest echo showed no swelling of the left ventricle or atrium?
How far apart were your last 2 scans? the one where the mitral was normal and the one where it now shows as mild.

[ocean12]

I can't thank you enough for your "very easy to understand explanation".  From what you know about this in your opinion, can this potentially mean that I will have problems with the quality of the repair and efficiency of the way my valve now works and will be in the near future?  The valve is leaking mild now, which didnt leak at all up until this last echo. my fear is that it will turn into moderate.

Any further information for you(or anybody who has had this personally) would be greatly appreciated. Thanks again:)))

[ed34]

I think this occurs when the left ventricle remodels itself. When you had your mitral valve surgery, I assume the situation was severe? It could be that the left ventricle remodelled itself in order to try and compensate for the valve insufficiency. If I had to guess, I would say that as your ventricle has returned back to a normal shape/size, then it has affected the papillary muscles which pull on tiny chords called chordals. These are what control the valve leaflets. In surgery they cut these and re-attach them so the valve leaflets can reach an open and closed position. I am suggesting it is due to the heart re-modelling because you had an  annuloplasty ring, which is to make the opening for the valve the correct shape etc. SO in very basic terms, if the ring was put in place when your heart was out of shape, due to self modification to compensate for a leaking mitral valve, and surgery was performed to align the leaflets, there is a big chance that as the heart has modified itself back towards a normal shape, that the valve has been affected again, squashed or pulled out of shape. This is not as uncommon as you think and is why valves should be repaired before they reach the severe stage of leaking.