Mitral Valve Regurgitation

In mitral valve regurgitation, the mitral valve leaks, allowing blood to flow backwards through the heart and into the lungs. Over time this condition can damage the heart and cause symptoms such as shortness of breath, irregular heartbeats, and pain.

Mitral Valve Prolapse

Mitral valve regurgitation is sometimes caused by mitral valve prolapse, a relatively common and benign condition in which the mitral valve bulges a little bit, so that the leaflets do not close properly. This allows some blood to leak backwards into the ventricle.

Mitral valve prolapse, also referred to as the floppy mitral valve syndrome, is very common, especially among women. In fact, many experts consider it a variation of normal function rather than a disease per se. Mitral valve prolapse is known for causing a characteristic clicking sound that a doctor can usually hear. The floppy valve also may allow a backflow of some of the blood that normally should pass through the valve to the left ventricle.

Most of the time, the condition is benign and entirely asymptomatic. In other instances, it can cause a variety of rather vague symptoms, including palpitations, chest pain, easy fatigue, feelings of breathlessness, and perhaps fainting. In rare cases, the person may develop serious cardiac arrhythmias. Recurrences can be prevented by establishing the proper diagnosis—an echocardiogram can detect the abnormal valve—and administering beta-blockers or other medication to control the heart rhythm.

Symptoms of Mitral Regurgitation

Many patients have no symptoms for years, but when symptoms appear, they commonly include:

  • Shortness of breath
  • Fatigue
  • Palpitations
  • Atrial fibrillation

Causes of Mitral Regurgitation

In the United States, mitral regurgitation is most commonly caused by:

  • Degeneration of the valve
  • Damage to the heart after heart attack
  • Rheumatic heart disease
  • Infective endocarditis
  • Cardiomyopathy

Diagnosing Mitral Regurgitation

In many cases, people can have a diseased heart valve for many years without suffering any symptoms or even being aware of the problem. Diseased valves can be detected by murmurs or other unusual sounds heard through a stethoscope. Ultrasound examination of the heart, also 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. Depending upon the type of valvular problem, patients often can go for many years without any special treatment.

Echocardiogram (ECHO)

A sound wave picture of the heart that gives information about the heart valves and the function of the muscular walls of the heart.

Echocardiography Laboratory

This diagnostic laboratory houses the region's only computerized, digital equipment for three-dimensional rest and exercise echocardiography ('stress echo'), which allows stress echo results to be transmitted to any site on earth for instantaneous peer consultation. In addition, the pediatric echocardiography laboratory specializes in fetal sonography and the diagnosis of congenital heart disease.

After performing a full diagnostic battery, our specialists will then make recommendations about treatment options.

Treatment of Mitral Regurgitation

Depending on the severity of the leakage, mitral regurgitation can be treated by valve repair rather than replacement. Repair of the mitral valve is usually recommended in patients whose mitral regurgitation is caused by:

  • Degenerative valve disease
  • Infective endocarditis
  • Ischemic heart disease

If mitral valve disease is mild, symptoms may be alleviated with medications. If the disease is more severe, such that left ventricular dysfunction is present, the current preferred treatment is surgical repair of the mitral valve.

During surgery to repair the mitral valve, the surgeon accesses the heart through a sternotomy (opening of the chest bone) and excises or repositions the diseased valve leaflets. In instances where the valve is severely diseased a surgeon will perform a valve replacement using a mechanical or bioprosthetic valve. Advantages of surgery include an improved quality of life and longer life expectancy.

MitraClip

MitraClip, a catheter-based treatment for mitral valve regurgitation, is available for patients who are at high risk of open surgery and who have degenerative mitral regurgitation. In this procedure, a metal clip is advanced on a catheter delivery system, most often through the femoral artery in the groin, and guided by a special type of x-ray into the mitral valve. The MitraClip device then clips the leaflets of the valve together to reduce the amount of blood that flows back into the left atrium. MitraClip is not FDA approved for patients with functional (ischemic) mitral regurgitation, although patients with this form of mitral valve disease may be eligible for device through participation in the COAPT trial. Read more here.

Structural Mitral Disease

Structural mitral regurgitation refers to leakage caused by a structural abnormality of the mitral valve.

Causes of structural mitral disease may include:

  • a congenitally malformed valve (abnormal at birth)
  • mitral prolapse
  • rheumatic fever
  • infection
  • degeneration due to aging

Functional Mitral Disease

Functional mitral regurgitation, or FMR, refers to conditions in which the mitral valve is structurally normal, but which leaks as a result of damage to the heart muscle (size or shape) from coronary artery disease, heart attack, or other condition.

FMR may be considered ventricular disease because it occurs when blood leaks back into the atrium from the ventricle. As the flow of blood to the body decreases, the heart works harder to compensate, causing the left ventricle to enlarge. This dilation causes increased regurgitation from the mitral valve.

In mild cases, patients may be unaware that they have mitral regurgitation. If it persists, FMR may lead to atrial fibrillation and congestive heart failure, which may cause symptoms including

  • Shortness of breath
  • Dizziness
  • Chest pain
  • Fatigue

COAPT Trial

Patients who have been diagnosed with moderate-to-severe or severe functional mitral regurgitation (a form of mitral regurgitation in which the valve is structurally normal but leaks because of changes to the size and/or shape of the heart) and who are too high risk to undergo mitral valve surgery may be eligible to participate in the COAPT Trial (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Patients Trial). This trial is evaluating the safety and effectiveness of the MitraClip device in Participation in a clinical trial is always on a voluntary basis. For further information please contact The Heart Valve Centerat 212.342.0444.