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Mitral Valve Chordae Repair

The human heart is basically a pump that receives blood from the body after the oxygen and nutrients have been extracted from the blood by the body's organs. The heart can be thought of as being divided into a right and left side. Both halves of the heart are made up of an atrium that receives the blood and a ventricle that pumps the blood. The right side of the heart receives the blood from the body after it has circulated. The blood is then pumped to the lungs, where the CO2 is removed and Oxygen is added to the blood. The blood leaves the lungs and enters the left side of the heart, which then pumps the newly oxygenated blood back out to the body.

There are four valves located in the heart, two on the right and two on the left. All of the valves in the heart are supposed to be one-way valves--that is, they are supposed to allow the flow of blood in only one direction. The Mitral valve is located in the left atrium, which receives the newly oxygenated blood from the lungs. The mitral valve is made up of two leafets, which resemble two halves of a tiny parachute. These leaflets are connected to the inside of the left ventricle by the chordae tendonae, which act as guide wires to the leaflets and help open and close the valve during the normal cardiac cycle.

There are numerous conditions that can cause the mitral valve to not act as a one-way valve. When this happens the valve condition is referred to as mitral insufficiency or mitral regurgitation. A small amount of leak (insufficiency or regurgitation) is usually not symptomatic and may be detected with a physical exam. Usually mild insufficiency can be treated with medicines. However, when the valve leakage becomes significant, it can cause shortness of breath, difficult breathing with exercise, or congestive heart failure. If not treated in a timely fashion, this can lead to permanent heart and lung damage.

One of the causes of mitral valve insufficiency can be secondary to a stretched or broken chordae tendonae. Again, if you think of the valve leaflets and the chordae acting as a parachute, you can envision what would happen if one of the guide ropes of the parachute broke. When the mitral valve leaks significantly, surgery to repair the valve is indicated. The video shows the surgeon repairing the mitral valve by using a man-made fiber (Goretex) to replace stretched or broken chordae. This operation is being done with robotic assistance, but the valve can be repaired using conventional surgical approaches as well. Your surgeon will advise what surgical approach would be best for your condition.

By correcting the chordae, the leaflets of the mitral valve will meet in the correct plane and once again function as a one-way valve. The symptoms caused by the leaking mitral valve will resolve with successful repair unless the condition has been allowed to progress and permanently affect the heart and lung function.


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