If you are breathless at rest, unable to lie flat, or coughing up blood, seek emergency care today. Acute mitral regurgitation and severe stenosis can decompensate rapidly and need treatment where you are.
The mitral valve sits between the left atrium and the left ventricle. It can leak backwards (regurgitation), narrow so blood struggles through (stenosis), or do both at once — and the treatment differs sharply between them.
One decision dominates this condition: repair or replace. Where repair is possible it is almost always the better outcome, and yet replacement is offered far more often than it should be — partly because repair is technically harder and demands a surgeon who does it regularly.
The mitral valve has two leaflets, anchored by fine cords to muscles inside the ventricle. It is a more intricate structure than the aortic valve, and it can fail in more ways.
In mitral regurgitation the valve does not close properly and blood leaks backwards into the left atrium with every beat. The commonest cause is degeneration of the leaflets or rupture of one of the supporting cords — often called prolapse. It can also occur when the ventricle enlarges after a heart attack and pulls the valve out of shape, which is a different problem requiring a different approach.
In mitral stenosis the leaflets thicken and fuse so the opening narrows. In the countries our patients travel from, this is overwhelmingly rheumatic in origin, and it has its own dedicated page.
The distinction matters because the treatments diverge completely. A narrowed rheumatic valve may be opened with a balloon and no surgery at all. A leaking degenerative valve usually needs surgical repair — and in experienced hands, repair rather than replacement is achievable in the large majority of cases.
Mitral regurgitation that has developed over years is usually a condition to plan around carefully. Mitral regurgitation that appears suddenly — typically when a supporting cord ruptures or after a heart attack — is an emergency, because the heart has had no time to adapt. If your breathlessness came on over hours or days rather than months, go to hospital now.
Two echocardiograms tell most of the story: one from the chest wall, and often one from behind the heart.
This is the single most useful question you can put to any surgeon, and the answer should come from a transoesophageal echocardiogram rather than a guess. Repair preserves your own tissue, generally gives better long-term ventricular function, and avoids a prosthesis and its consequences entirely. If you are being offered replacement, ask why repair is not possible — and if the answer is vague, send us the study.
What is possible depends on whether your valve is leaking or narrowed, and on what a transoesophageal echocardiogram shows.
For mild or moderate disease without symptoms, regular echocardiograms and treatment of blood pressure, atrial fibrillation and fluid retention. Anticoagulation is usually needed where atrial fibrillation is present, because the stroke risk is significant.
The surgeon reconstructs your own valve — resecting a prolapsing segment, replacing ruptured cords with artificial ones, and usually placing a supporting ring around the valve opening. It avoids a prosthesis entirely, generally preserves ventricular function better than replacement, and in most cases avoids lifelong anticoagulation. It is technically demanding and depends heavily on the surgeon's experience with the operation.
The valve is removed and replaced with a mechanical or tissue prosthesis. Necessary where the valve is too damaged to reconstruct, which is more common in rheumatic than degenerative disease. A mechanical valve in the mitral position requires warfarin for life without exception.
Balloon valvuloplasty for suitable rheumatic mitral stenosis opens the valve without surgery. For selected patients with severe regurgitation who are poor surgical candidates, an edge-to-edge clip delivered by catheter can reduce the leak. Neither replaces surgery for a patient who can safely have it.
These are separate diseases with separate treatments. Establishing which you have — and whether both — is the first step, and it comes from the echo report.
For regurgitation, this is the pivotal question and it needs a transoesophageal study to answer properly. Repair rates vary enormously between surgeons, which is precisely why we select on volume in this specific operation.
A mechanical mitral valve means warfarin for life and regular INR testing. If that monitoring is not reliably available near your home, it should weigh heavily — and it is another argument for repair wherever it is achievable.
We select mitral surgeons on their repair rate, not their total case numbers. A surgeon who replaces most of the valves they see is not the same as one who repairs most of them.
If your symptoms have changed quickly, that usually means something structural has changed too. See a doctor locally first and send us the reports afterwards.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Because it keeps your own valve. Repair generally preserves the pumping function of the ventricle better, avoids the risks that come with a prosthesis, and in most cases means no lifelong warfarin. Where a valve is genuinely repairable, repair is the better operation — the constraint is usually surgical experience rather than your anatomy.
A transoesophageal echocardiogram is the test that answers it. If you have not had one, that is the study to ask for. Send us whatever echo reports you do have and Dr. Varughese will tell you whether repair looks likely, and what further imaging is needed to be certain.
After a successful repair, usually only for a short period, unless you have atrial fibrillation. After a mechanical mitral valve replacement, warfarin is required for life with regular INR testing, without exception. After a tissue valve replacement, generally not long term. This difference is one of the strongest arguments for repair.
Minimally invasive mitral surgery through a small incision between the ribs is performed at several centres in Delhi NCR, and for suitable patients it means less pain and faster recovery. It is not right for every anatomy, and it should never be chosen over a better operation. Ask what the surgeon's repair rate is with the minimally invasive approach specifically.
Yes. It raises your stroke risk and usually means anticoagulation is needed regardless of the valve decision. It can also often be treated during the same operation with a maze procedure, and the left atrial appendage closed to reduce future stroke risk. Mention it in your first message.
Usually not yet. Moderate regurgitation with a normal-sized, normally functioning ventricle and no symptoms is generally monitored rather than operated on. What matters as much as the leak grade is whether the ventricle has started to enlarge — which is why the full echo report matters more than the one-line conclusion.
Send the echocardiogram report. The question Dr. Varughese will answer first is whether your valve can be repaired rather than replaced.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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