Harvard Heart Letter

Ask the doctors: Do I need valve surgery?

Q. I have a heart murmur that my doctor says is caused by a leaky mitral valve. I feel perfectly fine, am an active gardener, and enjoy playing with my grandchildren. My last echocardiogram showed that my heart is getting bigger, and my doctor says it is time to operate on the valve. Isn't this suggestion a bit drastic?

A. Your heart is enlarging because it has to pump blood twice: that is, every time your heart beats, some blood shoots in the wrong direction, back toward the lungs. That blood must re-enter the left ventricle and get pumped a second time in the right direction, which is out the aorta and into the body. Over time, the extra work takes a toll on your heart. If your heart is enlarging, it may mean that it is on its way to becoming permanently damaged.

It is always tricky for someone who feels fine to contemplate surgery. The danger is that if you wait until you experience the symptoms of heart failure, too much damage will have occurred, and you may not regain your normal heart function after the valve has been repaired or replaced. So operating when the left ventricle is enlarging is a very reasonable approach.

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