Dear Doctors: I’ve been getting dizzy when I exercise or even stand up too fast. I got sent to a cardiologist who says it’s mitral valve stenosis. He thinks I’m a good candidate for a catheter repair that uses a balloon. A friend who had that says it’s not a big deal. Is that really true? I’m worried.
Dear Reader: The mitral valve separates the two left chambers of the heart. The mitral valve is made up of two thin and flexible flaps of tissue called leaflets. At the start of a heartbeat, the leaflets open to release blood from the upper chamber, or left atrium. After the heartbeat moves the blood into the lower chamber, or left ventricle, the leaflets snap shut. This forms a seal that prevents backwash. The flow of blood in only one direction is crucial for good blood pressure so oxygenated blood moves out to the tissues of the body.
In mitral valve stenosis, the leaflets have thickened and become stiff. They cannot open easily, which makes the valve narrower. This narrowing is known as stenosis. Mitral valve stenosis makes the heart work harder. This can cause the left atrium to become enlarged. It can also prevent all the blood from leaving the chamber during a heartbeat. This increases the risk of an abnormal heartbeat (called atrial fibrillation) and blood clots. It can also lead to secondary pulmonary hypertension, a type of localized high blood pressure.
The procedure your cardiologist recommended is a balloon mitral valvuloplasty. This minimally invasive surgery can alleviate the symptoms of mitral valve stenosis. Symptoms include the dizziness you described, as well as shortness of breath, chest discomfort and fatigue. If successful, balloon valvuloplasty minimizes the risks of living with mitral valve stenosis. It can also prevent a valve replacement. A valve replacement surgery is more complicated and has a longer recovery time.
For a balloon mitral valvuloplasty procedure, patients first get an IV line inserted. The IV line can deliver sedative medication and fluids during surgery. Patients are awake but sedated for this surgery. The care team connects the patient to monitors that record vital signs and electrical activity in the heart and display the structures of the heart. The surgeon inserts a thin, hollow tube called a catheter into a vein. Often this procedure goes through the femoral vein in the groin area. The patient gets an injection of a local anesthetic at the site of insertion to manage pain.
The catheter has a tiny balloon at the tip. The surgeon threads the catheter through the vein. With the aid of imaging scans and contrast dye, they guide it to the mitral valve. There, they inflate the balloon, sometimes a few times, to widen the valve. Then, they deflate the balloon, remove the catheter and close the insertion site. The procedure takes about an hour, but patients often stay in the hospital overnight.
While this surgery is not very invasive, it’s misleading to say it’s not a big deal. Any surgery has risks. Your cardiologists can discuss these with you and help you decide whether to move forward with the surgery.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
