Leaky Heart Valve Surgery Advised

People with severely leaky heart valves that cause no symptoms -- a situation thought to be relatively harmless -- actually are in danger of dying and should consider surgery to get the problem fixed right away, a new study suggests.

Such people are five times more likely to die of a heart problem or develop heart failure or an irregular heartbeat than those with mild leakage, researchers at the Mayo Clinic reported in today’s issue of the New England Journal of Medicine.

“When it’s severe, it’s fixable. And we can determine when it’s severe now with new techniques,” said Dr. Maurice Enriquez-Sarano, who led the study.

Of the estimated 2.7 million Americans with notable leakage, about 600,000 are probably candidates for early surgery, Sarano said.

The study involved the mitral valve, which connects the upper left chamber with the heart’s main pumping chamber. If the valve’s two flaps don’t close tightly, blood can leak back into the upper chamber when the heart contracts.

Most people don’t feel anything, but if it gets worse, they can develop shortness of breath, fatigue, dizziness and palpitations.

Doctors can detect the condition by listening to the heart, but usually don’t recommend surgery to repair or replace the valve unless it causes symptoms or damages the heart itself.

The Mayo researchers used a relatively new ultrasound technique to measure the hearts of 456 patients who had leaky valves but no symptoms. They found that the size of the hole in the valve was the strongest predictor of how the patient would fare. Without surgery, those with bigger holes -- about the width of a pencil -- did the worst.

Study participants were enrolled between 1991 and 2000. All had leaky heart valves without symptoms and no other heart problems. Their disorder was classified mild, moderate or severe based on the volume of their leakage and the size of the valve hole.

Participants were monitored and treated independently by their own physicians, and updated information on the patients was collected by the researchers in 2002.

Their findings showed age, diabetes and the valve hole were strong predictors of survival.

Eventually, 232 had heart surgery, all but two for valve repair or replacement.

The researchers said surgery reduced the patients’ risk of heart failure and death and their life expectancy returned to normal.