DR. MARK J. RUSSO, MD, MS

Contact Us

The Mitral Valve and Related Conditions

What is
the Mitral Valve?

The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. Normally the flaps are held tightly closed during left ventricular contraction (systole) by the chordae tendineae (small tendon “cords” that connect the flaps to the muscles of the heart). In Mitral Valve Prolapse (MVP), the flaps enlarge and stretch inward toward the left atrium, sometimes “snapping” during systole, and may allow some backflow of blood into the left atrium (regurgitation). 

What is Mitral Regurgitation?

Mitral valve regurgitation (MR), also known as a leaking mitral valve, Barlow’s syndrome, occurs when one or both of the flaps may not close properly, allowing the blood to leak backward (regurgitation). This regurgitation may result in a murmur (abnormal sound in the heart due to turbulent blood flow). Mitral regurgitation (backward flow of blood), if present at all, is generally mild.

What is Mitral Regurgitation?

What is the cause of Mitral Regurgitation?

The most common cause of primary mitral regurgitation in the United States (causing about 50% of primary mitral regurgitation) is myxomatous degeneration of the valve. This causes a stretching out of the valve leaflets and the chordae tendineae. The elongation of the valve leaflets and the chordae tendineae prevent the valve leaflets from fully coapting when the valve is closed, causing the valve leaflets to prolapse into the left atrium, thereby causing mitral regurgitation.

 

Ischemic heart disease causes mitral regurgitation by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valve annulus.

 

Rheumatic fever and connective tissue disease (e.g. Marfan’s syndrome and Ehlers Danlos Syndrome) are other typical causes of mitral regurgitation. 

 

Secondary mitral regurgitation is due to the dilatation of the left ventricle, causing stretching of the mitral valve annulus and displacement of the papillary muscles. This dilatation of the left ventricle can be due to any cause of dilated cardiomyopathy, including aortic insufficiency, nonischemic dilated cardiomyopathy. It is also called functional mitral regurgitation, because the papillary muscles, chordae, and valve leaflets are usually normal.

 

Acute mitral regurgitation is most often caused by infaction of the heart valve. Papillary muscle rupture or dysfunction, including mitral valve prolapse are also common causes in acute cases.

What are the symptoms of Mitral Regurgitation?

Depending on the severity of the leak, each individual may experience symptoms differently. Symptoms may include:

  • Weakness
  • Fatigue
  • Shortness of breath.
  • Atrial Fibrillation and/or Palpitations
  • Chest pain 

The left atrium and/or left ventricle may become enlarged

Depending on the severity of the leak into the left atrium during systole (mitral regurgitation), the left atrium and/or left ventricle may become enlarged, leading to symptoms of heart failure. These symptoms include weakness, fatigue, and shortness of breath.

What are the symptoms of Mitral Regurgitation?

What is Mitral Regurgitation treated?

The standard of care for patients with symptomatic mitral regurgitation (including mitral valve prolapse) is mitral valve surgery repair or replacement.  This can be performed via minimally invasively and with a catheter (Mitraclip).  RWJUH also offers investigational devices in the setting of clinical trials.

Frequently Asked Questions about Mitral Valve Disease

Typically patients have no new restrictions after the procedure, and (unless a mechanical valve is placed) there are no new medications that need be taken as a result of receiving the new valve.

Although they vary by patient. The risks of both procedures are death, bleeding, stroke, infection, and vascular injury. In a typical patient the risk of anyone of these complication is less than 1-2%.

Ideally, patients should be treated within 1-3 weeks. Treatment of aortic stenosis is typically not an emergency. However significant delays can pose a risk of heart failure, hospitalization, and sudden cardiac death.

If untreated, 50% of patients with severe aortic stenosis die 18 months years after symptoms are detected. And if untreated ultimately nearly all patients die from this condition within 5 years.

The likelihood of need a valve replaced depends on age at the time of initial surgery (Ann Thor Surg, 2015):

For patients < 60 years, at :

  • 10 years, 5.6% (95% CI, 4.7 to 6.8);
  • 15 years, 20% (95% CI, 17 to 23); and
  • 20 years, 45% (95% CI, 39 to 52)


60 to 80 years old, at:

  • 10 years, 1.5% (95% CI, 1.3 to 1.7);
  • 15 years, 5.1% (95% CI, 4.4 to 5.8), and
  • 20 years, 8.1% (95% CI, 6.7 to 9.7)

  • at 80+ years: unlikely
  • Transthoracic echo
  • Gated cardiac CT
  • Pre-admission testing Cardiac catheterization — for some patients
  • Cardiac CT can be performed without the need for cardiac cath


Administrative staff will help find a date for treatment Nursing coordinatots will provide instruction on preparation

To schedule an in-person or telemedicine consultation with Dr. Russo,
please call 732-235-7231 or send an email.

Commonly Performed Procedures

Minimally invasive valve surgery is a specialized approach to treating heart valve disease that avoids the need to “crack the chest.” This method uses sophisticated instruments to perform the surgery through a smaller incision at the side of the chest and offers the patients less pain and faster recovery. We perform nearly all of our isolated valve surgeries minimally invasively.

An aortic aneurysm is a bulging, weakened area in the wall of main blood vessel in the body. The risk of aortic catastrophe, including dissection and rupture, increases dramatically with an aneurysm. Surgery may be recommended when the aorta is larger than 4.5-6 cms. Factors including family history, lifestyle, and need for other heart surgery guide decisions about surgery.​​

An aortic aneurysm is a bulging, weakened area in the wall of main blood vessel in the body. The risk of aortic catastrophe, including dissection and rupture, increases dramatically with an aneurysm. Surgery may be recommended when the aorta is larger than 4.5-6 cms. Factors including family history, lifestyle, and need for other heart surgery guide decisions about surgery.​​

A “bypass” or “cabg” surgery is the most commonly performed heart surgery. It is necessary when the coronary arteries, which provide blood to the heart become narrow preventing sufficient blood from passing through, and thus depriving the heart of oxygen and nutrients. RWJUH has CABG outcomes that exceed national benchmarks.

When other treatments are insufficient, a heart transplant is a surgical procedure offered to patients with the most severe damage to the heart. RWJUH is one of a limited number of centers in the US that offer advance heart failure surgery, including heart transplant. Dr. Russo has participated in 500+ successful transplant surgeries.

When other treatments are insufficient, a heart transplant is a surgical procedure offered to patients with the most severe damage to the heart. RWJUH is one of a limited number of centers in the US that offer advance heart failure surgery, including heart transplant. Dr. Russo has participated in 500+ successful transplant surgeries.

Clinical Trials at RWJUH

Transcatheter aortic valve replacement vs OMM (randomized) for asymptomatic severe AS The EARLY TAVR trial (Edwards) looks at transcatheter aortic valve replacement (TAVR) as an effective treatment for patients with asymptomatic aortic stenosis. Patients are randomized to either treatment with TAVR or clinical surveillance until the develop symptoms, at which point they are eligible to be treated with TAVR.  Read More

This study objective is to establish the safety and effectiveness of the Edwards SAPIEN 3/ SAPIEN 3 Ultra Transcatheter Heart Valve in subjects with moderate, calcific aortic stenosis. Patients are randomized to S3 TAVR device or medical management.  Read More

ALIGN-AR evaluates the safety and probable benefit of the transfemoral JenaValve Pericardial TAVR System in patients with symptomatic severe aortic regurgitation. Patients who are high risk for open surgical aortic valve replacement/repair are eligible. RWJUH is one of only 15 centers in the U.S. that can offer this therapy that has been granted a “Breakthrough Device Designation” by the US Food and Drug Administration. This designation is reserved for investigative therapies designed to treat a serious or life-threatening disease or condition and where preliminary clinical evidence indicates that the therapy may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints, such as substantial treatment effects observed early in clinical development.

Transcatheter aortic valve replacement for severe AS with a novel deviceEvaluates the safety and efficacy of Acurate (Boston Scientific) valve for transcatheter aortic valve replacement. For patients with severe aortic stenosis who are at intermediate or greater risk for SAVR. Patients are randomized to Acurate or commerical TAVR device. Read More

The study is a prospective, multi-center, randomized controlled pivotal clinical trial to evaluate the safety and effectiveness of the EVOQUE System with optimal medical therapy (OMT) compared to OMT alone in the treatment of patients with at least severe tricuspid regurgitation. Subjects will be followed at discharge, 30 days, 3 months, 6 months and annually through 5 years.

This study will establish the safety and effectiveness of the SAPIEN M3 System in subjects with symptomatic, at least 3+ mitral regurgitation (MR) for whom commercially available surgical or transcatheter treatment options are deemed unsuitable.

The SUMMIT-Tendyne trial (Abbott) evaluates the safety and effectiveness of using the Tendyne Mitral Valve System for the treatment of symptomatic mitral regurgitation or mitral annular calcification in patients who are not appropriate for conventional mitral valve surgery. In the randomized arm, patients are treated with either the Tendyne device or MitraClip, while patients in the non-randomized and MAC arms receive the Tendyne device. https://clinicaltrials.gov/ct2/show/NCT03433274

The SUMMIT-Tendyne trial (Abbott) evaluates the safety and effectiveness of using the Tendyne Mitral Valve System for the treatment of symptomatic mitral regurgitation or mitral annular calcification in patients who are not appropriate for conventional mitral valve surgery. In the randomized arm, patients are treated with either the Tendyne device or MitraClip, while patients in the non-randomized and MAC arms receive the Tendyne device. https://clinicaltrials.gov/ct2/show/NCT03433274

CLASP IID/F is a prospective, multicenter, randomized, controlled pivotal trial to evaluate the safety and effectiveness of transcatheter mitral valve repair in patients with degenerative/functional mitral regurgitation with the Edwards PASCAL Transcatheter Valve Repair System compared with the commercially available device (Abbott MitraClip).

RESTORE is a prospective, multicenter, non-randomized trial designed to evaluate the safety and effectiveness of the HARPOON™ Beating Heart Mitral Valve Repair System in patients with severe degenerative mitral regurgitation (DMR).

PBS: Heart Disease OnCall

Video Cover
Play Video about Video Cover

Newest heart valve options

Video Cover
Play Video about Video Cover

Miracle transplant at RWJUH

Video Cover
Play Video about Video Cover