Mitral Valve Regurgitation

Causes of mitral valve regurgitation

Mitral valve regurgitation can be caused by a problem with the valve itself. This is a condition called primary mitral valve regurgitation. Causes can include:

• A birth defect. Mitral valve malformations are often complex. They may occur on their own, or as part of another congenital heart defect.
• Rheumatic fever. This inflammatory condition can develop when strep throat or scarlet fever aren't treated with antibiotics. It can damage the heart and the proper functioning of the mitral valves.
• Aging. The wear and tear of aging can cause deterioration of the mitral valves.

In secondary (or functional) mitral valve regurgitation, the condition is caused by coronary artery disease (CAD) or cardiomyopathy.

Symptoms of mitral valve regurgitation

Symptoms of mitral valve regurgitation can vary depending on how well the valve is working. If the regurgitation is mild to moderate, people can have the condition for years without experiencing problems. In this case, treatment may not be needed at all, though your doctor may choose to monitor your condition. If you have moderate to severe mitral valve regurgitation, symptoms may be more apparent because your body is likely working harder to keep blood flowing to the heart.

Depending on the severity of your condition, symptoms may include:

• Shortness of breath with exertion
• Shortness of breath when lying down
• Tiredness
• Decreased ability to exercise
• Unpleasant awareness of heartbeat or a fluttering sensation in the chest
• Swollen lower extremities (legs, feet and ankles)
• Swollen abdomen or distended neck veins

Diagnosis of mitral valve regurgitation

Our team of specialists at the UCSF Heart Valve Disease Clinic work collaboratively to evaluate each patient and determine the best treatment plan to meet individual needs. To diagnose mitral valve regurgitation and determine its severity, doctors may order some of the following tests:

• Blood test. We look at a variety of health-related factors in the blood, such as red blood cell numbers and electrolyte levels (amounts of elements, such as sodium and potassium.) Blood tests can also provide information on how well the kidneys, liver and thyroid are functioning. In some instances, blood test results will point to the cause of a heart problem.
• Chest x-ray. A chest x-ray shows the size of the heart and may reveal fluid buildup in the lungs.
• Electrocardiogram (ECG). An ECG (also known as EKG) is a painless test used to detect enlarged heart chambers, heart disease and abnormal heart rhythms. During this test, electrodes are applied to the skin. Wires connect the electrodes to a monitor that records the heart's electrical activity.
• Transesophageal echocardiogram (TEE). A transesophageal echocardiogram uses sound waves to capture clear images of the heart's chambers, valves and blood flow. A TEE can also show whether blood clots are forming in the pumping heart.
• Cardiac catheterization. This test may be used to look at valve leakage and rule out coronary artery disease, particularly in older patients. It collects detailed images of the heart to provide information on its functional and structural health.

Treatment of mitral valve regurgitation

If you have mild mitral valve regurgitation, you may not need treatment right away. Your doctor will monitor your condition and may prescribe medication to relieve symptoms.

If your condition is more severe, you may need to have the valve repaired or replaced. Depending on the condition of your heart and your overall health, your doctor will recommend one of the following procedures:

• Open-heart surgery. During an open-heart surgery, the leaking valve is repaired or replaced. It is replaced with a mechanical valve or one made of pig, cow or human heart tissue. During surgery, the patient's heart is temporarily stopped to allow work on the valve, so a heart-lung bypass machine is used to circulate blood through the body.
• Minimally invasive mitral valve surgery. This surgery may be an option for patients who have regurgitation but no other serious heart problems. The valve leakage is repaired using a tiny camera and specialized instruments that pass through a small incision. As in open-heart surgery, the patient is on a heart-lung bypass machine during the procedure, but the recovery is much faster, with less pain and scarring.
• Transcatheter mitral valve repair with MitraClip. A valve repair with MitraClip is a minimally invasive procedure where a catheter is threaded through a blood vessel to the mitral valve to implant a device that reduces the backflow of blood. The MitraClip is placed across the valve's two flaps, which helps them close more securely. The procedure doesn't require making incisions in the chest or temporarily stopping the heart.
• Transcatheter mitral valve replacement. This procedure may be recommended for patients who are not candidates for either open-heart or minimally invasive valve repair. In this procedure, the doctor delivers a collapsible replacement valve to the heart using a catheter threaded through a blood vessel. The new valve is released inside the old valve and takes over the job of controlling the blood flow. Potential recipients may need to undergo further evaluation, such as a CT scan or other procedures.