The mitral valve is a part of the cardiac skeleton (between the left atrium and left ventricle), which has three components – the annulus, leaflets and subvalvular apparatus(chordae tendinae , papillary muscle and the left ventricle). These help in providing adequate opening and closure of the valves during the cardiac cycle.
Any pathology that distorts this architecture can interfere with the valve function thus affects the cardiac function. The pathology can either be rheumatic, degenerative or functional which can lead to mitral valve regurgitation or stenosis.
These conditions when diagnosed early are managed conservatively. The question of type of surgical intervention arises when there is worsening of the grade of regurgitation or stenosis and when LV contractility is hampered due to chronicity of the disease or in some cases can be acute(as in myocardial infarction).
When valves are not amendable to repair , replacement is done. Replacement can be done using mechanical or bioprosthetic valves where predominantly age is the determining factor. As bioprosthetic valves can undergo degenerative changes over time (expectancy of approximately 10 - 15 years) it is preferred in patient more than 55 years of age. Mechanical valves are preferred in young age , but have the necessity to take life long anticoagulants. Bioprosthetic valves are preferred in young females who have not completed their family in view of the anticoagulation required.
