Learn more about the symptoms and treatment of the most common heart valve condition, which causes blood to leak backward in the heart.
Mitral valve regurgitation is a type of heart valve disease in which the valve between the left heart chambers doesn't close completely, allowing blood to leak backward across the valve. It is the most common type of heart valve disease (valvular heart disease). If the leakage is severe, not enough blood will move through the heart or to the rest of the body. As a result, mitral valve regurgitation can make you feel very tired (fatigued) or short of breath.
Other names for mitral valve regurgitation are:
Treatment of mitral valve regurgitation may include regular monitoring, medications or surgery. Some people with mitral regurgitation don't need treatment, especially when the regurgitation is mild.
Severe mitral valve regurgitation often requires a catheter procedure or heart surgery to repair or replace the mitral valve. Without proper treatment, severe mitral valve regurgitation can cause heart rhythm problems (arrhythmias) or heart failure.
Mitral valve regurgitation is often mild and progresses slowly. Some people with mitral valve regurgitation might not have symptoms for many years.
But sometimes, mitral valve regurgitation develops quickly. This condition, called acute mitral valve regurgitation, causes sudden signs and symptoms.
Fatigue is a common but nonspecific symptom of mitral valve regurgitation. Other signs and symptoms of mitral valve regurgitation include:
If you develop symptoms that suggest mitral valve regurgitation or another problem with your heart, see your health care provider right away.
If you have a heart murmur, you may be referred to a doctor that specializes in heart diseases (cardiologist).
To understand the causes of mitral valve disease, it may be helpful to know how the heart works.
The mitral valve is one of four valves in the heart that keep blood flowing in the right direction. Each valve has flaps (leaflets) that open and close once during each heartbeat. If a valve doesn't open or close properly, blood flow through the heart to the body can be reduced.
In mitral valve regurgitation, the valve flaps don't close tightly. Blood leaks backward when the valve is closed, making it harder for the heart to work properly.
If mitral valve regurgitation is due to problems with the mitral valve, the condition is called primary mitral valve regurgitation.
If a problem or disease affecting other areas of the heart cause a leaky mitral valve, the condition is called functional or secondary mitral regurgitation.
Possible causes of mitral valve regurgitation include:
A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.
Several things can increase the risk of mitral valve regurgitation, including:
Mitral valve regurgitation complications often depend on the severity of disease. Mild mitral valve regurgitation usually does not cause any problems.
As mitral valve regurgitation gets worse, the heart must work harder to pump blood to the body. The strain on the heart can cause the left lower chamber to widen. The heart muscle may become weak.
Potential complications of severe mitral valve regurgitation include:
To diagnose mitral valve regurgitation, a health care provider will usually do a physical exam and ask questions about your symptoms and medical history, including whether you have mitral valve prolapse. The provider will typically listen to your heart with a stethoscope. A heart murmur, also called a holosystolic murmur, may be heard. The mitral valve heart murmur is the sound of blood leaking backward through the valve.
Tests may be done to confirm a diagnosis of mitral valve regurgitation or to check for other conditions that can cause similar signs and symptoms.
Common tests to diagnose mitral valve regurgitation include:
Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the structure of the mitral valve and blood flow in the heart. A standard echocardiogram, also called a transthoracic echocardiogram (TTE), can confirm a diagnosis of mitral valve regurgitation and determine its severity. Echocardiography can also help in the diagnosis of congenital mitral valve disease, rheumatic mitral valve disease and other heart valve conditions.
Sometimes, a transesophageal echocardiogram (TTE) may be done to get a closer look at the mitral valve. In this type of echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from the mouth to the stomach (esophagus).
After testing confirms a diagnosis of mitral or other heart valve disease, your health care provider may tell you the stage of disease. Staging helps determine the most appropriate treatment.
The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.
Heart valve disease is staged into four basic groups:
How well a person does after being diagnosed with mitral valve regurgitation varies. The outlook (prognosis) for mitral valve regurgitation depends on:
About one in 10 people with chronic mitral valve regurgitation due to prolapse needs surgery to repair or replace the valve.
The goals of mitral valve regurgitation treatment are to improve heart function while reducing signs and symptoms and avoiding future complications. Some people, especially those with mild regurgitation, might not need treatment. Your health care provider will consider your symptoms and stage of regurgitation, among other things, when discussing treatment options with you.
Treatment of mitral valve regurgitation may include:
A doctor trained in heart disease (cardiologist) typically provides care for people with mitral valve regurgitation. If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of health care providers trained and experienced in evaluating and treating heart valve disease.
Medications may be needed to reduce mitral valve regurgitation symptoms and to prevent complications of heart valve disease.
Types of medications that may be prescribed for mitral valve regurgitation include:
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 health care provider can discuss the risks and benefits of each type of heart valve with you to determine which valve may be best for you.
If you need surgery for another heart condition, a surgeon might perform mitral valve repair or replacement at the same time as that other surgery.
Mitral valve surgery is usually done through a cut (incision) in the chest. Surgeons at some medical centers sometimes use robot-assisted heart surgery, a minimally invasive procedure in which robotic arms are used to do the surgery.
Mitral valve repair saves the existing valve and may preserve heart function. Whenever possible, mitral valve repair is recommended before considering valve replacement. People who have mitral valve repair for mitral regurgitation at an experienced medical center generally have good outcomes.
During mitral valve repair surgery, the surgeon might:
Other mitral valve repair procedures include:
During mitral valve replacement, the surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Sometimes, a heart catheter procedure is done to place a replacement valve into a biological tissue valve that no longer works well. This is called a valve-in-valve procedure.
If you had mitral valve replacement with a mechanical valve, you'll need to take blood thinners for life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.
In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).
Your health care provider may suggest that you make several heart-healthy lifestyle changes. Take these steps:
Women with mitral valve regurgitation should talk to their health care provider before trying to get 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 the heart pumps.
If you think you have mitral valve regurgitation, make an appointment to see your health care provider. Here's some information to help you prepare for your appointment.
For mitral valve regurgitation, some basic questions to ask your health care provider include:
Don't hesitate to ask other questions you have.
Your health care provider is likely to ask you a number of questions, including: