Mitral valve regurgitation

Overview

Mitral valve regurgitation is a common type of heart valve disease, also called valvular heart disease. In this condition, the valve between the left heart chambers doesn't close fully. Blood leaks backward across the valve. If a lot of blood leaks backward, the rest of the heart and body doesn't get enough blood. Mitral valve regurgitation can make you feel very tired or short of breath.

Other names for mitral valve regurgitation are:

• Mitral regurgitation (MR).
• Mitral insufficiency.
• Mitral incompetence.

Treatment of mitral valve regurgitation may include regular health checkups, medicines or surgery. You may not need treatment if the condition is mild. If it's severe, you may need a catheter treatment or heart surgery to fix or replace the valve. Without proper treatment, severe mitral valve regurgitation can cause irregular heartbeats or heart failure.

Causes

To understand the causes of mitral valve disease, it may help to know how the heart works.

The mitral valve is one of four valves in the heart. Heart valves keep blood flowing in the right direction. Each valve has flaps, also called leaflets. The leaflets open and close once during each heartbeat.

In mitral valve regurgitation, the valve flaps don't close tightly. Blood moves backward when the valve is closed. This makes it harder for the heart to work as it should.

If mitral valve regurgitation is due to changes in the mitral valve, the condition is called primary mitral valve regurgitation.

If a condition or disease in other areas of the heart cause the valve to leak, the condition is called functional or secondary mitral regurgitation.

Possible causes of mitral valve regurgitation include:

• Mitral valve prolapse. The valve's flaps bulge back into the left upper heart chamber when the heart squeezes. This is a common type of heart valve disease. It can prevent the mitral valve from closing tightly.
• Rheumatic fever. Rheumatic fever is a complication of untreated strep throat. Rheumatic fever can damage the mitral valve, leading to mitral valve regurgitation early or later in life. If rheumatic fever causes mitral valve disease, the condition is called rheumatic mitral valve disease. Rheumatic fever is rare in the United States.
• Heart attack. A heart attack can damage the area of the heart muscle that supports the mitral valve. If there is a lot of heart attack damage, mitral valve regurgitation can occur. A leaky mitral valve caused by a heart attack is called ischemic mitral regurgitation.
• Heart condition present at birth, also called a congenital heart defect. Some people are born with heart structure changes that affect the heart valves.
• Thickening of the heart muscle, called cardiomyopathy. Thickening of the heart muscle makes it harder for the heart to send blood to the rest of the body. The condition can affect how the mitral valve works, causing regurgitation. Types of cardiomyopathy linked to mitral valve regurgitation include dilated cardiomyopathy and hypertrophic cardiomyopathy.
• Damaged tissue cords. Over time, the pieces of tissue that hold the flaps of the mitral valve to the heart wall may stretch or tear. This is especially likely in people with mitral valve prolapse. Or a chest injury can damage the cords. A tear can cause blood to suddenly move backward through the mitral valve. Surgery may be needed to repair the valve.
• Inflammation of the inner lining of the heart's chambers and valves, called endocarditis. An infection usually causes this condition. Germs get into the bloodstream and stick to damaged areas in the heart.
• Radiation therapy. Radiation therapy for cancer in the chest area can lead to mitral valve regurgitation. However, this is rare.

Complications

Mitral valve regurgitation complications often depend on how severe the disease is. Mild mitral valve regurgitation usually does not cause any complications.

Possible complications of severe mitral valve regurgitation include:

• An irregular and often very fast heartbeat, called atrial fibrillation. Mitral valve regurgitation may trigger this common heart rhythm disorder. Atrial fibrillation, also called AFib, increases the risk of blood clots and stroke.
• High blood pressure in the lungs, called pulmonary hypertension. Long-term untreated or improperly treated mitral regurgitation can make the pressure in the lungs' blood vessels go up. As pressure rises, fluid builds up in the lungs.
• Congestive heart failure. In severe mitral valve regurgitation, the heart has to work harder to pump enough blood to the body. The extra effort causes the left lower heart chamber to get bigger. Untreated, the heart muscle becomes weak. This can cause heart failure.

Treatment

The goals of mitral valve regurgitation treatment are to:

• Help the heart work better.
• Reduce symptoms.
• Prevent complications.

Some people, especially those with mild regurgitation, might not need treatment. Your healthcare team considers your symptoms, stage of valve disease and your overall health when planning treatment.

Treatment of mitral valve regurgitation may include:

• Healthy lifestyle changes.
• Regular health checkups.
• Medicines to treat symptoms and prevent complications, such as blood clots.
• Surgery to repair or replace the mitral valve.

A doctor trained in heart diseases typically cares for people with mitral valve regurgitation. This type of healthcare professional is called a cardiologist.

If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of healthcare professionals trained and experienced in evaluating and treating heart valve disease.

Medications

You may need medicines to reduce mitral valve regurgitation symptoms and to prevent complications.

Types of medicines that may be used for mitral valve regurgitation include:

• Water pills, also called diuretics. This type of medicine reduces or prevents fluid buildup in the lungs and other parts of the body.
• Blood thinners, also called anticoagulants. If you have atrial fibrillation due to mitral valve disease, such as mitral valve regurgitation, you may get these medicines to prevent blood clots. Atrial fibrillation increases the risk of blood clots and stroke.
• Blood pressure medicines. High blood pressure makes mitral valve regurgitation worse. If you have mitral valve regurgitation and high blood pressure, you may get medicines to lower blood pressure.

Surgery or other procedures

A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don't have symptoms. Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement. Your healthcare team talks with you about the risks and benefits of each type of heart valve to decide which valve may be best for you.

If you need surgery for another heart condition, a surgeon might do mitral valve repair or replacement at the same time as that other surgery.

Mitral valve surgery is usually done through a cut in the chest. Surgeons at some medical centers sometimes use robot-assisted heart surgery. This is a minimally invasive procedure in which the doctor uses robotic arms to do the surgery.

Mitral valve repair

Mitral valve repair saves the existing valve. It also may protect how the heart works. Whenever possible, surgeons recommend mitral valve repair before valve replacement. People who have valve repair for mitral regurgitation at an experienced medical center generally have good outcomes.

During mitral valve repair surgery, the surgeon might:

• Patch holes in a heart valve.
• Reconnect the valve flaps.
• Remove excess tissue from the valve so that the flaps can close tightly.
• Repair the structure of the mitral valve by replacing cords that support it.
• Separate valve leaflets that have connected.

Other mitral valve repair procedures include:

• Annuloplasty. A surgeon tightens or reinforces the ring around the valve, called the annulus. Annuloplasty may be done with other methods to repair a heart valve.
• Valvuloplasty. This treatment is used to fix a mitral valve with a narrowed opening. You may have this treatment even if you don't have symptoms. It's done using a thin tube called a catheter with a balloon on the tip. The surgeon inserts the tube into an artery in the arm or groin and guides it to the mitral valve. The balloon is inflated. This makes the valve opening wider. The balloon is then deflated. The catheter and balloon are removed.
• Mitral valve clip. In this treatment, a doctor guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip helps the mitral valve flaps close more tightly. The treatment reduces the amount of blood moving backward across the valve. This treatment is an option for people who have severe mitral valve regurgitation or who aren't good candidates for mitral valve surgery.

Mitral valve replacement

During mitral valve replacement, the surgeon removes the mitral valve. It's replaced with a mechanical valve or a valve made from cow, pig or human heart tissue. A tissue valve also is called a biological tissue valve.

Sometimes, doctors use thin tubes called catheters to put a replacement valve into a biological tissue valve that no longer works well. This is called a valve-in-valve procedure.

If you have a mechanical valve, you need blood thinners for life to prevent blood clots. Biological tissue valves can break down over time and may need to be replaced.

If you've had mitral valve replacement, your healthcare professional usually tells you to take antibiotics before dental procedures. This helps prevent a heart infection called infective endocarditis.

Preparing for an appointment

If you think you have mitral valve regurgitation, make an appointment for a health checkup. You might be sent to a doctor trained in heart diseases, called a cardiologist. Here's some information to help you prepare for your appointment.

What you can do

• When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat or drink for a few hours before a cholesterol test.
• Write down your symptoms, including any that seem unrelated to mitral valve regurgitation. Note when they started, and what you were doing when they started.
• Write down important personal information. Include any family history of heart disease, congenital heart conditions, stroke, high blood pressure or diabetes. Also note any major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you take. Include the dosages.
• Take someone with you, if possible. Someone who goes with you can help you remember information you're given.
• Be prepared to talk about your diet and exercise habits. If you don't already eat well and exercise, be ready to talk with your healthcare team about challenges you might face in getting started.
• Write down questions to ask your healthcare team.

For mitral valve regurgitation, some basic questions to ask a healthcare professional include:

• What is likely causing my condition?
• What are other possible causes?
• What tests do I need?
• What's the best treatment?
• What are other treatment options?
• I have other health conditions. How can I best manage them together?
• What changes do I need to make to my diet or activities?
• If I need surgery, which surgeon do you recommend for mitral valve repair?
• Is there any information that I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your healthcare team usually asks you many questions, including:

• When did your symptoms start?
• Do you always have symptoms, or do they come and go?
• On a scale of 1 to 10, with 10 being the worst, how bad are your symptoms?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?