Definition and Overview

Mitral valve regurgitation is the most common type of heart valve disorder that occurs when the mitral valve does not close properly. The condition is also sometimes called mitral incompetence or mitral insufficiency.

The mitral valve is located on the left side of the heart. It helps control the flow of blood from the upper to the lower heart chamber. If it fails to close completely as it is supposed to when the heart contracts, some of the blood that is meant to be sent to the body flows back into the upper heart chamber. This creates a problem as the body will have an insufficient supply of oxygen-rich blood. To prevent complications including organ malfunction, the body makes adjustments and the heart is forced to work much harder than it should to pump more blood. Unfortunately, this can weaken the heart muscle over time, which places the patient at risk of congestive heart failure.

Causes of Condition

Mitral valve regurgitation causes include:

  • Heart attack

  • Heart valve infections

  • Mitral valve prolapse

  • Coronary heart disease

  • High blood pressure

  • Rheumatic heart disease

  • Inflammation of the lower part of the left heart chamber

  • Damaged tissue cords

  • Cardiomyopathy

  • Physical trauma

  • Congenital heart defects

  • Rare medical conditions, such as Marfan syndrome

  • Excessive or prolonged use of medications that contain ergotamine

  • Radiation therapy on the chest area

The blood may regurgitate back into the upper heart chamber when the:

  • Muscles around the mitral valve become damaged, which usually occurs following a heart attack

  • Cords attached to the muscles of the valve become broken

  • Valve is destroyed due to an infection

Mitral valve regurgitation sometimes begins suddenly but may go away without treatment. This is usually the case when the condition is caused by a recent heart attack. It is considered chronic if it does not go away or recur repeatedly.

Key Symptoms

The signs and symptoms of mitral valve regurgitation are:

  • Cough

  • Fatigue

  • Exhaustion

  • Lightheadedness

  • Breathing difficulty

  • Palpitations or a rapid heartbeat

  • Excessive urination, especially at night

The symptoms of the condition tend to develop gradually over a long period, so they are not immediately noticeable. However, there are many cases wherein patients do not present with symptoms.

In severe cases, mitral valve regurgitation may also cause signs that indicate right-sided heart failure. These include:

  • Swollen leg or ankle

  • Bulging neck veins

  • Enlarged liver

When patients present with the above symptoms, doctors listen to their heart and lungs using a stethoscope to check for:

  • An extra heart sound or a gallop

  • A distinct mitral valve regurgitation murmur

  • A thrill or vibration

  • A crackling sound when the fluid backs up into the lungs

A person with mitral valve regurgitation may also suffer from symptoms that signal a possible complication. These include:

  • Chills

  • Fever

  • Headache

  • Muscle aches

  • General feeling of being ill

Who to See and Types of Treatments Available

A person with the above symptoms can consult a general practitioner but may be referred to a cardiac specialist if mitral valve problems are suspected.

Aside from the physical examination of the chest, patients will also undergo an echocardiogram, an ultrasound scan of the heart, as well as other imaging tests such as a CT (computed tomography) scan and an MRI (magnetic resonance imaging). These tests provide detailed pictures of the heart, making it easier for doctors to spot any abnormalities and decide on the best treatment plan for the patient.

Patients may also undergo exercise stress tests to evaluate their heart’s response to physical activity. If they are unable to exercise for certain reasons, they are simply given medications that mimic the effects of exercise on the heart.

Another diagnostic test that may be performed is called cardiac catheterisation, which involves threading a thin catheter through a blood vessel and injecting a contrast dye material into it. The contrast dye material makes it easier to evaluate the arteries during imaging tests.

Mitral valve regurgitation treatment options include:

Medications - Patients are usually given medications to reduce the strain on their heart. These medications are especially important for patients with weak heart muscles or those suffering from high blood pressure. These medications include:

  • Beta-blockers

  • Angiotensin-converting-enzyme (ACE) inhibitors

  • Calcium channel blockers

  • Blood thinners

  • Diuretics

Mitral valve regurgitation surgery - The primary surgical treatment for the condition is a valve repair procedure. If it is no longer possible to repair the valve, the patient has to undergo a valve replacement surgery, which is usually prescribed if the patient’s heart function is very poor, the symptoms are worsening, and the heart has become enlarged or dilated.

  • A mitral valve replacement surgery replaces the damaged valve with an artificial one, which can be either man-made or biological harvested from a cow, pig, or diseased human donor. Unlike synthetic valves, biological valves have to be replaced over time as they degenerate.

  • Mitral valve repair and replacement surgery can now be performed through minimally invasive methods, such as robot-assisted heart surgery, mini-sternotomy, or thoracoscopic surgery.

Lifestyle changes - Patients are advised to adopt a healthier lifestyle, maintain a healthy weight, avoid or reduce alcohol consumption and smoking, and to be physically active.

Patients also need long-term monitoring so their doctor can track their symptoms and evaluate their heart function. Long-term monitoring can help doctors detect complications early, which may include:

  • Atrial fibrillation

  • Arrhythmias

  • Blood clots, which can travel to the lungs or brain and obstruct blood flow

  • Heart valve infection

  • Pulmonary hypertension

  • Heart failure

  • Endocarditis

References:

  • Al-Attar N. “Surgery in severe mitral regurgitation: Focus on patients with no symptoms or complications.” ESC Council for Cardiology Practice. 2014 Jan 14. Vol. 12. No. 12. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-12/Surgery-in-severe-mitral-regurgitation-focus-on-patients-with-no-symptoms-or-co

  • Luna M. “Treating Mitral Regurgitation in 2017.” UT Southwestern Medical center. 2017 Mar 10. https://cme.utsouthwestern.edu/sites/cme.utsouthwestern.edu/files/em1703n_031017_protocol_luna.pdf

  • Songia P, Porro B, Chiesa M, et al. “Identification of Patients Affected by Mitral Valve Proplapse with Severe Regurgitation: A Multivariable Regression Model.” Oxidative Medicine and Cellular Longevity. https://www.hindawi.com/journals/omcl/2017/6838921/ Ahmed M, Roshdy A, Sharma R, Fletcher N. “Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review.” Echo Res Pract. 2016 Mar; 3(1): D1-D8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402658/

  • De Bonis M, Al-Attar N, Antunes M, Borger M, et al. “Surgical and interventional management of mitral valve regurgitation: a position statement from the European Society of Cardiology Working Groups on Cardiovascular Surgery and Valvular Heart Disease.” Eur Heart J. 2016. 37(2): 133-139. https://academic.oup.com/eurheartj/article/37/2/133/2398345/Surgical-and-interventional-management-of-mitral

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