What is mitral valve regurgitation?

Mitral valve regurgitation occurs when blood leaks backward through the mitral valve as the left ventricle contracts. When this happens, blood can flow both in and out of the ventricle and atrium during a contraction.

Mitral valve regurgitation is classified as primary, caused by abnormality in the mitral valve, or secondary, caused by abnormality in the left ventricle.

Approximately half of the adult population has some degree of mitral regurgitation.

Causes of mitral valve regurgitation

Mitral valve prolapse is a primary cause of mitral valve regurgitation. Mitral valve prolapse can prevent the mitral valve from closing tightly, which could lead to mitral valve regurgitation.

Other conditions that are associated with mitral valve regurgitation include:

  • Rheumatic fever
  • Kawasaki disease
  • Myocarditis (inflammation of the heart muscle)
  • Endocarditis
  • Cardiomyopathy
  • Rheumatoid arthritis
  • Lupus
  • Heart attack

Risk factors for mitral valve regurgitation

Risk factors of mitral valve regurgitation include:
  • Congenital heart defect — some infants are born with a mitral valve that is prone to regurgitation and are at higher risk of developing the condition later in life.
  • History of mitral valve stenosis, mitral valve prolapse or heart valve disease — if you have a history of heart valve disease, mitral valve stenosis or mitral valve prolapse, you are more likely to develop regurgitation.
  • Age — most cases of mitral valve regurgitation are in patients over 40 years old.
  • Heart attack — heart attacks can affect the mitral valve and put you at higher risk for regurgitation.
  • History of infections such as rheumatic fever or endocarditis — rheumatic fever or endocarditis can damage the mitral valve and put patients at risk for developing mitral valve regurgitation later in life.
  • Use of medications for migraines or appetite suppression — use of certain medications for migraines and appetite suppression (most now are off the market) puts you at higher risk for developing mitral valve regurgitation.

Symptoms of mitral valve regurgitation

Chest pain is the most common symptom of mitral valve regurgitation. Other symptoms of mitral valve regurgitation include:
  • Lightheadness
  • Shortness of breath
  • Palpitations (more common when lying on the left side)
  • Fatigue
Severe mitral valve regurgitation could lead to heart failure, which can cause symptoms such as:
  • Coughing
  • Congestion around the heart and lungs
  • Swelling in the legs and feet

Diagnosis of mitral valve regurgitation

During a physical exam your doctor will listen to your heart. If he or she hears a heart murmur, other diagnostic tests may be ordered such as:
  • Echocardiogram — uses sound waves to determine if there are any abnormalities in the heart; the most commonly used test to diagnose mitral valve regurgitation.
  • Transesophageal echocardiogram — provides a more detailed close-up view of the heart by inserting a device into the esophagus.
  • Electrocardiogram (ECG or EKG) — can show heart disease, an enlarged heart or abnormal heart rhythms.
  • Chest x-ray — produces images of the heart and lungs, if the left ventricle is enlarged, this could indicate mitral valve regurgitation.
  • Cardiac MRI — can evaluate the seriousness of your condition as well as take detailed images of the left ventricle to assess for size and function.

Treatment for mitral valve regurgitation

Your Mercy Health doctor will develop a treatment plan based on the severity of your condition. In mild cases, monitoring by your physician may be all that is needed. Your doctor can regularly check the progression of mitral regurgitation and take more advanced steps when necessary.

When symptoms worsen, other treatments include:

Medications
Medications can help relieve the symptoms of mitral valve regurgitation. For example, if you have fluid buildup in the lungs or legs, your doctor may prescribe a diuretic.

Guidelines from the American College of Cardiology recommend surgery even if the mitral valve regurgitation is not causing symptoms.

Mitral valve surgical repair
When appropriate, your surgeon will try to preserve your own valve before replacing it. A surgeon can repair the leaking valve using your own heart tissue.
Benefits of mitral valve repair (over replacement) include:

  • Increased life expectancy
  • Improved lifestyle
  • Lower risk of infection or stroke
  • Preservation of heart function

Mitral valve replacement
Mitral valve replacement is an open-heart procedure that replaces the damaged mitral valve with a mechanical or tissue valve. There are risks and benefits to both valves, so your doctor will work with you to determine which option is best for you.

During the procedure, you will be placed on a heart-lung machine while the damaged heart valve is removed and replaced.

Recovery from a heart valve surgery can take months. It is important to work with your cardiac doctors and nurses to develop a recovery plan that includes exercise, healthy eating, stress reduction and cardiac rehabilitation.

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