Guide to Mitral Valve Regurgitation

What Is Mitral Valve Regurgitation?

Mitral regurgitation is the backward flow of blood through the heart. This occurs when the heart's mitral valve doesn't close tightly. When the mitral valve doesn't work properly, blood can't move through the heart as efficiently as it should, which means it also can’t get out to the rest of the body as well as it normally would.  This can result in feeling tired or out of breath. 

Mitral valve regurgitation is also called mitral insufficiency or mitral incompetence.

What Causes Mitral Valve Regurgitation?

Mitral valve regurgitation can be caused by many things, including

  • Mitral valve prolapse: Mitral valve prolapse is a condition in which the leaflets and tendon-like cords supporting the mitral valve weaken. The result is that with each contraction of the left ventricle, the valve leaflets bulge (prolapse) up into the left atrium. This may prevent the mitral valve from closing tightly and lead to regurgitation. However, mitral valve prolapse is common and most people who have it never develop severe regurgitation.
  • Damaged heart tissue cords: Mitral valve regurgitation may result from damage to the tissue cords that anchor the flaps of the mitral valve to the heart wall. Over time, these cords may stretch or suddenly tear, especially in people with mitral valve prolapse. A tear of these cords can cause substantial leakage through the mitral valve and may require repair by heart surgery.
  • Rheumatic fever: Rheumatic fever is a complication of untreated strep throat and was once a common childhood illness in the United States. The infection may cause scarring of the mitral leaflets, leading to regurgitation. People with rheumatic fever, which is still common in countries where antibiotic use isn't common, may have both mitral valve stenosis and mitral valve regurgitation.
  • Prior heart attacks: A heart attack can damage the area of the heart muscle that supports the mitral valve, affecting the function of the valve. In fact, if the damage is extensive enough, a heart attack may result in sudden and severe mitral valve regurgitation. This sudden onset of regurgitation is sometimes referred to as acute mitral valve regurgitation.
  • High blood pressure: Yes. Over time, high blood pressure can cause your heart to work harder, and gradually your heart's left ventricle can enlarge. This can then stretch the tissue around your mitral valve, which can lead to leakage.
  • Congenital heart defects: Some people are born with damaged or improperly-functioning mitral valves. These congenital conditions may also be associated with other issues involving the heart’s anatomy.

What Are the Symptoms of Mitral Valve Regurgitation?

Mitral valve regurgitation signs and symptoms can include:

  • Blood flowing turbulently through the heart (heart murmur)
  • Shortness of breath, especially with exertion or when lying down
  • Fatigue, especially during times of increased activity
  • Lightheadedness
  • Cough, especially at night or when lying down
  • Heart palpitations — sensations of a rapid, fluttering heartbeat
  • Swollen feet or ankles
  • Excessive urination

Signs and symptoms of mitral valve regurgitation depend on its severity and how quickly the condition develops.

Mitral valve regurgitation is often mild and progresses slowly. People may have no symptoms for decades and be unaware that they have this condition. Mitral valve regurgitation is often first suspected when a doctor hears a heart murmur. Sometimes, however, the problem develops quickly, and people may experience a sudden onset of severe signs and symptoms. 

Severe mitral regurgitation may lead to complications including heart failure, atrial fibrillation, endocarditis, and pulmonary hypertension. Mild mitral valve regurgitation is unlikely to cause other problems.

How Is Mitral Valve Regurgitation Diagnosed?

Damaged mitral valves can be detected by a stethoscope when they cause murmurs or other unusual sounds. Ultrasound examination of the heart (called echocardiography), in which sound waves are used to map internal structures, is also helpful. The most precise diagnosis is made by cardiac catheterization and angiocardiography. 

How Is Mitral Valve Regurgitation Treated?

Mitral valve regurgitation is treated through procedures that either repair or replace the damaged mitral valve. Mitral valve repair involves fixing the existing valve, while mitral valve replacement means the surgeon puts in a new valve in place of the damaged, old one.  

Mitral valve procedures can be done through traditional surgical methods, like open surgeries, which involve cardiac surgeons accessing the valve through an opening in the chest, or minimally-invasive surgeries, which involve the surgeons entering the body through smaller incisions, often by the rib cage. The mitral valve can also be treated through catheter-based procedures like TMVR (Transcather Mitral Valve Repair/Replacement), another less invasive option where doctors access the valve through the bloodstream. 

The particular treatment approach depends on the severity of the mitral valve damage and the overall health of the person being treated.

For those with mild mitral regurgitation, treatment may not be necessary,though regular monitoring by a cardiologist is recommended. 

There are no medication that can fix a damaged mitral valve, but some can help deal with symptoms that accompany mitral valve regurgitation. Medications called diuretics are available to relieve fluid accumulation in the lungs or legs. Blood pressure medications can help with high blood pressure that may be worsening mitral valve regurgitation. Following a low-salt diet can also help prevent fluid buildup and control blood pressure.

If I Have Mitral Valve Regurgitation, What Are My Next Steps? 

If you are having symptoms of mitral valve regurgitation and need to confirm the diagnosis, you should schedule an appointment with a cardiologist. If you have already been diagnosed and need treatment or a second opinion, our cardiac surgeons are here to help.

Request an appointment today.

Next Steps

If you have heart disease and need help, we’re here for you. To get started today, call (212) 305-2633 or use our appointment request form.

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