Mitral Valve Regurgitation

The mitral valve is a one-way valve made up of two leaflets that conducts blood flow through the left side of the heart. When open, the mitral valve allows oxygenated blood from the lungs to fill the heart's main pumping chamber, the left ventricle. When the left ventricle squeezes to deliver blood throughout the body, the mitral valve normally closes to prevent blood from flowing back toward the lungs. 

Mitral regurgitation, also called insufficiency, is a condition when the mitral valve malfunctions and permits blood from the left ventricle to leak backwards towards the lungs. 

This condition is caused most often by congenital malformations (birth defects), or damage due to trauma, infection, or heart failure. Depending on the severity of the leakage, mitral regurgitation can lead to progressive lung congestion and heart failure.

Causes of Mitral Valve Regurgitation

Mitral valve regurgitation can be the result of several things, including:
  • Mitral valve prolapse (mitral valve does not close properly)
  • Damaged tissue
  • Congenital defects
  • A prior heart attack
  • Rheumatic fever
  • Endocarditis (inflammation of the heart valves)

Risks

Mitral valve regurgitation weakens the heart and can cause other more serious cardiac conditions. It is important to understand that having a risk factor does not mean that you will develop mitral valve regurgitation.

Some risks include:

  • Mitral valve prolapse or mitral valve stenosis: If you have a history of either one of these conditions, you may be at increased risk of developing mitral valve regurgitation.
  • Prior heart attack: A heart attack may damage your heart in a way that affects the ability of the mitral valve to close properly.
  • Medications: Certain medications, such as ergotamine or pergolide (and other products no longer available), have been associated with an increased risk of developing mitral valve regurgitation.
  • Congenital heart disease: Anyone who is born with an abnormal mitral valve is more likely to experience mitral valve regurgitation.

Symptoms

The symptoms of mitral valve regurgitation depend on how severe the condition is and how quickly it has developed. Mitral valve regurgitation can develop over time or suddenly. Symptoms may not occur until the condition becomes more serious.

If you have any of the following symptoms, it does not mean that you have mitral valve regurgitation. However, if you are experiencing the following symptoms, please contact your doctor, as severe mitral valve regurgitation that is left untreated can lead to other serious heart-related conditions.

Symptoms include:
  • Heart murmur
  • Shortness of breath, especially when your activity level is increased
  • Lightheadedness or fainting
  • Coughing, especially at night or when lying flat
  • Heart palpitations or a rapid fluttering heartbeat
  • Swelling of the feet or ankles

Diagnostic Tests

If you have symptoms of mitral valve regurgitation, our surgeons may choose to perform one or more of the following tests to determine if you have the condition.

Echocardiogram: An echocardiogram uses sound waves to create an image of the heart. Our surgeons can examine the image of the heart and the mitral valve to determine the cause of the mitral valve regurgitation and if it can be repaired or requires replacement.

Transthoracic echocardiogram (TTE): This is the most common way of performing an echocardiogram where images of the heart are obtained through the chest wall.

Transesophageal echocardiogram (TEE): This type of echocardiogram  requires passing a probe down your esophagus. It is more invasive, requiring sedation, but allows for an even clearer image of the heart than transthoracic echocardiograms. TEE is sometimes required prior to mitral valve  surgery.

Chest X-ray: A chest X-ray can show if the left ventricle appears enlarged, which may indicate mitral valve regurgitation. Occasionally, mitral valve regurgitation causes blood to back up into the lungs and cause congestion, which will also be visible on an X-ray. 

Electrocardiogram (ECG): An ECG measures the heart’s rhythm, which may reveal an arrhythmia, or heart rhythm irregularities. Irregularities may indicate mitral valve regurgitation.

Holter monitor: A Holter monitor is used to detect irregularities in the heart’s rhythm, which may be a sign of mitral valve regurgitation. This is a portable device usually worn by patients for anywhere from 24 to 72 hours and acts as a continuous ECG.

Exercise tests: Exercise tests are designed to measure the heart’s response to various levels of exertion to provide a better understanding of what is happening in the heart.

Cardiac catheterization: This can be used to diagnose mitral valve regurgitation but is generally used to check if you have concomitant coronary artery disease. 

Treatment

When regurgitation is severe enough, the mitral valve will need to be repaired or replaced, depending on the condition of the valve. Our surgeons are experts at performing minimally invasive mitral valve repair and replacement, which allows patients to experience less postoperative discomfort and enjoy quicker recovery times.

Valve repair: Mitral valve repair, or valvuloplasty, preserves the existing valve and is the preferred surgery for patients with mitral valve prolapse. Our expert cardiac surgeons can perform a valvuloplasty whereby the leaflets are reconstructed to close properly. 

Valve replacement: If your mitral valve is too damaged to repair, you may need to  undergo a valve replacement. A mechanical valve or biological tissue valve is used, depending on your age or other conditions. 

We understand that the thought of undergoing heart surgery can feel overwhelming. Our surgeons will review your surgical plan, in detail, so that you know what to expect before, during, and after your procedure. You can rest assured that you will be cared for by top surgeons internationally renowned for their minimally invasive techniques and innovative treatment strategies.