What kinds of surgery are available for problems with the Mitral Valve?

There are several options, depending on the exact type of problem, patient, and severity of the process.
Mitral valve repair. In many cases of mitral regurgitation, the problems that cause leakage can be repaired by a skilled surgeon without the need for replacement. Often, a valve "ring" is placed in the orifice that the mitral valve covers to "tighten up" the size of this area and allow the valve to cover it more effectively. The size and shape of the leaflets can be carefully remodeled, and torn structures sewn back together. Repair offers the advantage of improved left ventricular muscle performance, since the muscle (papillary muscles) and supporting structures (chordae tendiniae) are left intact. The long term results of repairing and saving the person's original "native" valve is often better than repair, with improved heart muscle function and decreased need for repeated surgical procedures. Furthermore, after repair there may be no need for long term anticoagulation. It is important to discuss this with your surgeon if you are planning to have surgery for mitral regurgitation.

Mitral commissurotomy. During this procedure, which is done for some people with mitral stenosis, the leaflets which have fused together at their "commissures" (points of touching) are separated by the surgeon. Like mitral valve repair for regurgitation, not all cases are suitable candidates for this approach, as sometimes the mitral valve is too calcified, or the leaflets cannot be separated in a satisfactory manner. Nowadays, many candidates for commissurotomy are treated with balloon mitral valvuloplasty.

Mitral valve replacement. Some mitral valves simply need to be replaced. This may not be known until the actual time of surgery, when a repair for regurgitation or a commisurotomy for stenosis can then be seen to be impossible or ill-advised. The valvular structure is cut out, and as much of the supporting structure left as feasible. The new valve may be mechanical or bioprosthetic (see explanation and picture below), and may be done from a standard approach across the breastbone ("median sternotomy"), or with some of the new "mini" approaches.

Balloon mitral valvuloplasty. This procedure is done in a manner similar to balloon coronary artery angioplasty. That is, access is gained to the circulation from the vessels in the legs, and a catheters with deflated balloons are advanced through the vessels to a position across the mitral valve. The balloons are then inflated, creating a somewhat uncontrolled but effective commissurotomy as described above. This all obviously occurs without having to enter the chest surgically, and is much easier on the patient in most cases. Again, not all people are candidates for balloon angioplasty, particularly those with heavily calcified valves. However, it is gaining increasing popularity in many centers.

Myocardial reduction procedure with mitral valve replacement (Battista procedure). In some cases of cardiomyopathy and congestive heart failure, the heart's natural tendency to dilate becomes massive, and becomes a problem of itself. It is often associated with substantial leakage through the mitral valve, as its annulus dilates. Battista, a surgeon in South America, pioneered a surgery which actually cuts out a very substantial part of the heart muscle, restoring it to a more efficient size. The mitral valve is also often removed in the course of this surgery. Although it is counterintuitive to cut out muscle from a weak organ, initial experience has been favorable.