LOS ANGELES (Sept. 1, 1999) -- For many years, Los Angeles dentist and pastor William Bredberg was like most people diagnosed with mitral valve prolapse (MVP)-aware of this quite common and typically harmless cardiac condition, but unhampered by symptoms that might interfere with a normal lifestyle. As a dentist and MVP patient, he knew that a dose of oral antibiotics was often recommended during dental work to guard against infection. Beyond that, his diagnosis of mitral valve prolapse was seldom given a second thought. That uncomplicated scenario changed quite dramatically two years ago.
"My endurance just wasn't what it used to be," recalled Dr. Bredberg, whose active lifestyle included regular walks, snow skiing and other physical activity. "I was always conscious of my health. I avoided elevators, instead taking the stairs to my third floor office. I started to notice that I was huffing and puffing more than usual."
For most people with mitral valve prolapse, few if any symptoms accompany the disorder, which affects an estimated 5 percent to 20 percent of the population. Also known as "click-murmur syndrome," the condition results when the mitral valve, which regulates blood flow on the left side of the heart, "prolapses"-or collapses backward. This sometimes allows small amounts of blood to leak back into the upper chamber of the heart, resulting in a "clicking" sound that can be heard with a stethoscope. Though most people have no symptoms, those who do commonly report palpitations, fatigue, mild shortness of breath and minor chest discomfort. For a very small percentage of those with MVP, a severe prolapse may require surgical intervention.
"Mitral valve prolapse is a very common diagnosis and, most of the time, it's a benign condition," explained cardio-thoracic surgeon Alfredo Trento, M.D., Director, Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center. "Sometimes there is a leak-though not in the majority of cases-that progressively worsens. When this occurs, we have to treat the leak to avoid serious complications, including enlargement of the heart."
Such was the case for Dr. Bredberg, who first scheduled appointments with his regular physician and a cardiologist. A stress electrocardiogram (EKG) and echocardiogram-standard tests used to diagnose MVP-indicated that the 55-year-old had a 30 percent blood flow back into the heart. It was decided to monitor the condition with regular EKGs. Then last October, Dr. Bredberg experienced an alarming episode while visiting in Santa Fe that determined the need for more aggressive treatment.
"I could tell that my heart was beating irregularly, and I called the paramedics," he remembered. " I was experiencing atrial fibrillation, and a defibrillator was used. I was then put on a fairly low dose of digoxen for six months and then, a few months later, I woke up with fibrillation again."
Another EKG was ordered, and a subsequent angiogram indicated a 50 percent to 75 percent "regurgitation" resulting from his mitral valve prolapse. Dr. Bredberg was referred to Dr. Trento for treatment. "It was 99 percent certain at this point that I would have to repair the valve eventually," Dr. Bredberg remembered. "It was also determined that the time to do this is while I was relatively young and in good health."
Since 1996, Dr. Trento and his associates at Cedars-Sinai have treated more than 100 patients annually with severe mitral regurgitation. Of these, approximately 80 percent will undergo valve repair, a successful alternative to more conventional valve replacement, according to Dr. Trento.
"For many years, faulty mitral valves were replaced with artificial valves, which was beneficial but not the perfect solution. The artificial valve, typically metal or porcine, is a foreign body, and patients have to rely on blood thinners the rest of their lives, plus the valves tend to last only a few years. Through the years, we have developed techniques to successfully repair most of these mitral valves, which is a real advancement in cardiac medicine."
Dr. Trento likens the mitral valve to a "parachute with strings" attached to the heart muscle. "Sometimes these strings break and, if there are several in one area, the valve will 'flail,' or flip back. That's where the leak occurs," he explained. "What we do is remove the piece of parachute with broken strings, and put it back together to create a smaller, more adequately working parachute."
Mitral valve repair, which Dr. Bredberg underwent in June 1999, requires open heart surgery because of the delicate work involved. Patients typically remain hospitalized for just five days after surgery to complete post-cardio rehab and to monitor their recovery.
"The evening after my operation, I was alert and experiencing no pain," said Dr. Bredberg. "During my hospital stay, they kept me up walking and exercising to prevent the tissue from scarring."
A month after surgery, Dr. Bredberg had already officiated at a wedding and was looking forward to returning to his part-time dental practice in another week. He was gradually increasing his exercise, walking about half an hour each day and climbing 400 to 500 stairs. "I feel excellent now, and I'm getting stronger every day," he related.
Dr Trento urges patients with serious mitral valve problems to ask their physicians about seeing a surgeon experienced in mitral valve repair.
"Many patients aren't aware they can have a repair rather than a replacement," he stressed. "I've treated many patients who were so grateful they could keep their own valve. These patients do very well and, with repair, the valve should last for good."
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