If you have been told you have a heart murmur, get an echocardiogram to learn more.

Many adults have been diagnosed with heart murmurs, which refers to the sound created by blood flow through the heart valves. But some murmurs are caused by defective valves, says the American Heart Association.

The mitral valve acts as a gate between the left atrium and left ventricle, the two chambers of the heart through which oxygenated blood from the lungs is pumped to the rest of the body. The valve has two moveable flaps that close to prevent blood from leaking from the ventricle back to the atrium or even into the lungs.

Mitral valve prolapse is one uncommon and usually harmless defect that affects the valve between the heart's left atrium and left ventricle. "About 21/2 percent of the population has mitral valve prolapse," says Farzad Najam,MD, a cardiothoracic surgeon at The George Washington University Hospital. Normally, the flaps open when the heart beats and close completely when it rests. If the valve doesn't close completely, blood can leak back into the atrium or lungs. The condition's most serious form, mitral valve regurgitation, can cause damage to the heart.

"Only about 10 to 15 percent of those with mitral valve prolapse will develop the more serious condition, mitral valve regurgitation, which requires surgery," says Dr. Najam.

A study that appeared in the New England Journal of Medicine earlier this year found that patients with moderate-tosevere mitral valve regurgitation are significantly more likely to die within five years than people without the condition.

Farzad Najam, MD Cardiothoracic Surgeon

"We may see heart failure if the problem advances," says Dr. Najam.

Risk Factors, Symptoms and Diagnosis
Women are more at risk for mitral valve prolapse, while men tend to be at increased risk for mitral valve regurgitation. "Even though women are less likely to require surgery, they still need to be monitored," says Dr. Najam.

Conditions that can lead to mitral valve defects include:

• Atherosclerosis (hardening of the arteries)
• Rheumatic heart disease
• High blood pressure
• Heart valve infection
• Cardiac tumors
• Inherited disorders, such as Marfan's syndrome or Graves' disease

Other risk factors include a family history of mitral valve defects and the use of the diet drugs fenfluramine and dexfenfluramine, which are no longer marketed in the United States.

Symptoms of mitral valve defects include:

• Shortness of breath
• Fatigue
• Exercise intolerance
• Heart arrhythmia
• Chest pain or discomfort
• A sense of a racing heart
• Dizziness
• Fainting
• Anxiety or panic attacks

Cynthia Tracy, MD Director of Cardiac Services

If you have been told you have a heart murmur, get an echocardiogram to learn more. If a mitral valve defect is diagnosed, your physician may recommend monitoring your condition if it is considered mild. If it's serious, surgery might be recommended.

Surgical Options
Patients who need surgery have two options: a mitral valve repair or a mitral valve replacement.

"The advantage of having a mitral valve repair is that we use the patient's own tissue to reconstruct the mitral valve. You could say it is plastic surgery of the mitral valve," says Dr. Najam. During the repair, surgeons reconstruct the valve and restore its normal function. After surgery, patients do not need to take blood-thinning medications.

"Our results with repairs are very good, in the range of 95 percent," says Dr. Najam. "That means that if 100 patients have this procedure, only five of them may come back for additional surgery in 10 or 15 years.

"For most patients who have this repair, they will no longer have symptoms, they will not need to take any more bloodthinning medication, and they will have a valve that will not deteriorate as time goes on," he says.

If the valve is not repairable, a mitral valve replacement is necessary. During this procedure, surgeons remove the mitral valve and replace it with either a mechanical valve or one made with tissue from a pig or cow.

Patients who require a mitral valve replacement choose the type of valve they want. "It's a personal choice. I have a very open discussion with the patient and explain the risks and benefits of both valves," says Dr. Najam.

"Some patients don't want to ever see another surgeon again and don't mind taking a blood thinner, so they choose the mechanical valve," he says. Other patients with an active lifestyle may not want to take blood-thinning medication because of the occasional scrapes and bruises they incur in their activities, he adds, "so they will take the chance of needing another operation in 15 to 20 years versus taking a blood thinner."

A Minimally Invasive Option
Traditionally, mitral valve repair or replacement has been performed as an open procedure, in which the breastbone (sternum) is split open with a 12- to 15-centimeter incision. Patients typically spend five to seven days in the hospital.

Now, minimally invasive mitral valve surgery is an option for patients who do not have coronary heart disease. The minimally invasive valve surgery may result in less trauma, less blood loss, smaller scars and less incision pain.

The procedure, called a ministernotomy, requires a partial opening of the breastbone through a 6- to 8-centimeter incision. Generally, these patients can leave the hospital three to six days following surgery.

"Patients who undergo standard surgery will not be allowed to drive or exercise for about six to eight weeks. But those who undergo a mini-sternotomy can drive in three to four weeks," says Dr. Najam. "In general, they feel very good. Just imagine -- before surgery they were having shortness of breath and difficulty exercising. Suddenly, they have a normal mitral valve and no symptoms. It takes time to recover from the trauma of any surgery, but basically these patients feel much better."

To schedule an appointment for an echocardiogram to determine if your heart murmur is serious, or to see a cardiothoracic surgeon, please call 1-888-4GW-DOCS.

Learn More! "Is Your Heart Murmur Harmless? Or Is It a Heart Valve Defect?" Nov. 16, 7–8:30 PM (Click here for more details.)

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