Learn more about the symptoms, diagnosis and treatment of this condition in which the heart's mitral valve leaks backward.
Mitral valve regurgitation — also called mitral regurgitation, mitral insufficiency or mitral incompetence — is a condition in which your heart's mitral valve doesn't close tightly, allowing blood to flow backward in your heart. If the mitral valve regurgitation is significant, blood can't move through your heart or to the rest of your body as efficiently, making you feel tired or out of breath.
Treatment of mitral valve regurgitation depends on how severe your condition is, whether it's getting worse and whether you have symptoms. For mild leakage, treatment is usually not necessary.
You may need heart surgery to repair or replace the valve for severe leakage or regurgitation. Left untreated, severe mitral valve regurgitation can cause heart failure or heart rhythm problems (arrhythmias). Even people without symptoms may need to be evaluated by a cardiologist and surgeon trained in mitral valve disease to determine whether early intervention may be beneficial.
Some people with mitral valve disease might not experience symptoms for many years. Signs and symptoms of mitral valve regurgitation, which depend on its severity and how quickly the condition develops, can include:
Mitral valve regurgitation is often mild and progresses slowly. You may have no symptoms for many years and be unaware that you have this condition, and it might not progress.
Your doctor might first suspect you have mitral valve regurgitation upon detecting a heart murmur. Sometimes, however, the problem develops quickly, and you may experience a sudden onset of severe signs and symptoms.
If your doctor hears a heart murmur when listening to your heart with a stethoscope, he or she may recommend that you visit a cardiologist and get an echocardiogram. If you develop symptoms that suggest mitral valve regurgitation or another problem with your heart, see your doctor right away. Sometimes the first indications are actually those of mitral valve regurgitation's complications, including heart failure, a condition in which your heart can't pump enough blood to meet your body's needs.
Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (leaflets or cusps) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart to your body.
In mitral valve regurgitation, the valve between the upper left heart chamber (left atrium) and the lower left heart chamber (left ventricle) doesn't close tightly, causing blood to leak backward into the left atrium (regurgitation).
Mitral valve regurgitation can be caused by problems with the mitral valve, also called primary mitral valve regurgitation. Diseases of the left ventricle can lead to secondary or functional mitral valve regurgitation.
Possible causes of mitral valve regurgitation include:
Several factors can increase your risk of mitral valve regurgitation, including:
When it's mild, mitral valve regurgitation usually does not cause any problems. However, severe mitral valve regurgitation can lead to complications, including:
Heart failure. Heart failure results when your heart can't pump enough blood to meet your body's needs. Severe mitral valve regurgitation places an extra strain on the heart because, with blood pumping backward, there is less blood going forward with each beat. The left ventricle gets bigger and, if untreated, weakens. This can cause heart failure.
Also, pressure builds in your lungs, leading to fluid accumulation, which strains the right side of the heart.
Your doctor will ask about your medical history and your family history of heart disease. Your doctor will also perform a physical exam that includes listening to your heart with a stethoscope. Mitral valve regurgitation usually produces a sound of blood leaking backward through the mitral valve (heart murmur).
Your doctor will then decide which tests are needed to make a diagnosis. For testing, you may be referred to a cardiologist.
Common tests to diagnose mitral valve regurgitation include:
Echocardiogram. This test is commonly used to diagnose mitral valve regurgitation. In this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest produce video images of your heart in motion.
This test assesses the structure of your heart, the mitral valve and the blood flow through your heart. An echocardiogram helps your doctor get a close look at the mitral valve and how well it's working. Doctors also may use a 3-D echocardiogram.
Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram. In this test, a small transducer attached to the end of a tube is inserted down your esophagus, which allows a closer look at the mitral valve than a regular echocardiogram does.
Mitral valve regurgitation treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse. The goal of treatment is to improve your heart's function while minimizing your signs and symptoms and avoiding future complications.
A doctor trained in heart disease (cardiologist) will provide your care. If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.
Some people, especially those with mild regurgitation, might not need treatment. However, the condition may require monitoring by your doctor. You may need regular evaluations, with the frequency depending on the severity of your condition. Your doctor may also recommend making healthy lifestyle changes.
Your doctor may prescribe medication to treat symptoms, although medication can't treat mitral valve regurgitation.
Medications may include:
Your mitral valve may need to be repaired or replaced. Doctors may suggest mitral valve repair or replacement even if you aren't experiencing symptoms, as this may prevent complications and improve outcomes. If you need surgery for another heart condition, your doctor may repair or replace the diseased mitral valve at the same time.
Mitral valve surgery is usually performed through a cut (incision) in the chest. In some cases, doctors may conduct minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.
Doctors at some medical centers may perform robot-assisted heart surgery, a type of minimally invasive heart surgery. In this type of surgery, surgeons view the heart in a magnified high-definition 3-D view on a video monitor and use robotic arms to duplicate specific maneuvers used in open-heart surgeries.
Your doctor will discuss with you whether mitral valve repair or mitral valve replacement may be most appropriate for your condition. He or she may also evaluate you to determine whether you're a candidate for minimally invasive heart surgery or open-heart surgery.
Doctors often may recommend mitral valve repair, as it preserves your own valve and may preserve heart function. However, if mitral valve repair isn't possible, doctors may need to perform mitral valve replacement.
Surgery options include:
Surgeons can repair the valve by reconnecting valve flaps (leaflets), replacing the cords that support the valve, or removing excess valve tissue so that the leaflets can close tightly. Surgeons may often tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).
Doctors may use long, thin tubes (catheters) to repair the mitral valve in some cases. In one catheter procedure, doctors insert a catheter with a clip attached in an artery in the groin and guide it to the mitral valve. Doctors use the clip to reshape the valve. People who have severe symptoms of mitral valve regurgitation and who aren't candidates for surgery or who have high surgical risk may be considered for this procedure.
In another procedure, doctors may repair a previously replaced mitral valve that is leaking by inserting a device to plug the leak.
If your mitral valve can't be repaired, you may need mitral valve replacement. In mitral valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Biological tissue valves degenerate over time, and often eventually need to be replaced. People with mechanical valves need to take blood-thinning medications for life to prevent blood clots.
Your doctor can discuss the risks and benefits of each type of heart valve with you and discuss which valve may be appropriate for you.
Doctors continue to study catheter procedures to repair or replace mitral valves. Some medical centers may offer mitral valve replacement during a catheter procedure as part of a clinical trial for people with severe mitral valve disease who are aren't candidates for surgery. A catheter procedure can also be used to insert a replacement valve in a biological tissue replacement valve that is no longer working properly.
Talk to your doctor about what type of follow-up you need after surgery, and let your doctor know if you develop new symptoms or if your symptoms worsen after treatment.
Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including:
If you're a woman with mitral valve regurgitation, it's important to talk to your doctor before you become pregnant. Pregnancy causes the heart to work harder. How a heart with mitral valve regurgitation tolerates this extra work depends on the degree of regurgitation and how well your heart pumps. Throughout your pregnancy and after delivery, your cardiologist and obstetrician should monitor you.
If you have mitral valve regurgitation, here are some steps that may help you cope:
If you think you have mitral valve regurgitation, make an appointment to see your doctor. Here's some information to help you prepare for your appointment.
For mitral valve regurgitation, some basic questions to ask your doctor include:
Don't hesitate to ask other questions you have.
Your doctor is likely to ask you a number of questions, including:
November 10th, 2021