Mitral Valve Regurgitation

What is mitral valve regurgitation?

Mitral valve regurgitation is the backward flow of blood through your mitral valve. This “door” connects the two chambers on the left side of your heart. It opens and closes in a rhythm that you know as your heartbeat. When your mitral valve opens, it lets blood flow from your top left chamber down to your bottom left chamber. When it closes, blood flow between those chambers pauses. The sealed door prevents blood from flowing back up into the top chamber so that it can go out of your heart to supply blood to your body.

But like other doors, your mitral valve can sometimes have trouble closing fully. This might be because the door itself (in this case, your valve tissue) is damaged. Or, damage to the walls and structures surrounding the door (the left chambers of your heart) might prevent it from working normally. In either case, your mitral valve can’t fully close. And some blood can leak out.

A door that’s slightly ajar in your home may cause minor trouble, like a bit of heat escaping from your room in the winter. But if the door is open too wide for too long, the impact is greater. Lots of heat will escape, and your furnace will have to work harder to make up for it.

It’s like that with your heart. A minor leak in your mitral valve might not make much of a difference. Your heart can easily compensate and you’ll feel fine. But if too much blood keeps leaking backward, your heart will have to work harder to send enough blood forward in the proper direction. Over time, this can take a toll on your heart, leading to symptoms and complications.

You may hear people refer to this condition by its shortened name, mitral regurgitation (MR). Other names include:

• Mitral valve insufficiency.
• Mitral valve incompetence.
• Leaky mitral valve.

What are the symptoms of mitral valve regurgitation?

Mild mitral regurgitation may not cause any symptoms. But as the leaky valve gets worse and affects your heart function, a common symptom is shortness of breath (dyspnea). You may feel like you can’t get enough air into your lungs, or you have to work harder to breathe, in one or more of these situations:

• During physical activity.
• At rest.
• When lying down.
• When trying to sleep.

Other symptoms can include:

• Atypical chest pain.
• Coughing.
• Swelling (edema) in your legs or feet.
• Feeling extremely overtired (fatigue).
• Feeling like you may faint without actually fainting (presyncope).
• Feeling like your heart is flip-flopping in your chest or skipping a beat (heart palpitations).

Symptoms may develop gradually or suddenly.

Call 911 or your local emergency number if you have symptoms of acute heart failure. These come on suddenly and include:

• Heavy breathing.
• Feeling like you’re suffocating.
• Struggling to breathe while lying down.
• Tight chest.
• Low blood oxygen with a home pulse oximeter (pulse ox).

Acute heart failure is a sudden, quick decline in heart function. It’s a medical emergency that can be life-threatening without immediate care.

What are the types of mitral regurgitation?

There are two main types of mitral regurgitation:

• Primary mitral regurgitation. In this case, the problem is the valve itself. Structural damage to one or more parts of the valve prevents it from closing normally. For example, the valve leaflets may become too stretchy to form a tight seal or too stiff to close.
• Secondary mitral regurgitation. In this case, the problem is heart disease that affects the chambers of the heart that support the valve (the left atrium or ventricle). For example, cardiomyopathy can cause your heart to grow larger and weaker. These changes can shift the positioning of the different parts of your valve and prevent its leaflets from fully closing.

MR of either type may be:

• Acute, developing suddenly and severely.
• Chronic, developing gradually over time.

Primary mitral regurgitation is when one or more parts of your valve are damaged. This damage prevents the valve from fully closing and causes some blood to leak backward into your left atrium.

What causes mitral valve regurgitation?

Mitral regurgitation happens when your valve fails to fully close. To understand how this happens, it helps to know a bit about your valve anatomy. Your mitral valve has two flaps (leaflets) that open and close to send blood from your top left chamber (left atrium) into your lower left chamber (left ventricle). Damage to the leaflets or other parts of the valve, and various medical conditions, can prevent your valve from closing tightly. As a result, some blood leaks backward each time your valve closes.

You might wonder, what prevents my valve from closing normally? The specific cause depends on the type of MR you have (primary or secondary).

The causes of primary mitral valve regurgitation include:

• Mitral valve prolapse (MVP), the most common cause in developed nations.
• Rheumatic heart disease, the most common cause globally.
• Connective tissue diseases.
• Cleft mitral valve, a congenital heart defect (a heart issue that you’re born with).
• Endocarditis.
• Radiation heart disease.
• Traumatic injury.

The causes of secondary mitral valve regurgitation include:

• Ischemic cardiomyopathy (most common).
• Atrial fibrillation.
• Dilated cardiomyopathy with an unknown (idiopathic) cause.
• Hypertrophic obstructive cardiomyopathy.

What are the complications of mitral valve regurgitation?

Mitral valve regurgitation can be life-threatening without treatment. Here are some possible complications:

• Your heart develops an irregular rhythm (atrial fibrillation), which sometimes leads to a stroke.
• Your heart can’t pump well enough to send a normal supply of blood to your body (heart failure).
• Blood pressure rises in the arteries that carry blood from your heart to your lungs (pulmonary hypertension).
• Your heart suddenly stops beating (sudden cardiac arrest).

How is mitral valve regurgitation diagnosed?

A thorough physical exam is the first step toward a diagnosis. Your healthcare provider will:

• Ask about your symptoms and medical history.
• Check your vital signs.
• Gently feel different areas of your body to look for signs of swelling (edema).
• Listen to your heart and lungs with a stethoscope (auscultation). The presence of a heart murmur may be a sign of valve disease.

Your provider may order tests to get further information.

What tests diagnose this condition?

Healthcare providers commonly use transthoracic echocardiogram (TTE) to diagnose mitral valve regurgitation. This painless, noninvasive test uses high-frequency sound waves to create images of your heart. It can show if you have a leaky valve or other problems with your heart structure or function. Because of where the mitral valve is located inside your body, your provider may need to get a better picture (closer view) of your valve using a transesophageal echocardiogram.

To further evaluate the severity of the condition or plan treatment, your provider may order additional tests, such as:

• Cardiac CT scan (computed tomography scan).
• Exercise stress echocardiogram (echo).
• Heart MRI (magnetic resonance imaging).
• Cardiac catheterization (cardiac cath or coronary angiogram).

What is the treatment for mitral valve regurgitation?

Treatment options for mitral valve regurgitation include:

• Mitral valve repair. This is open-heart surgery to repair your mitral valve.
• Minimally invasive mitral valve repair. This surgery repairs your valve using smaller incisions (surgical cuts).
• Mitral transcatheter edge-to-edge repair (TEER). For this procedure, your provider uses a long, thin tube called a catheter to attach a small clip to your valve leaflets. The clip helps the leaflets close more fully.
• Mitral valve replacement. This is open-heart surgery to give you a new mitral valve. Your valve may be either mechanical (made of carbon and steel) or bioprosthetic (made of animal tissue).
• Transcatheter mitral valve replacement (TMVR). This is a less invasive option to give you a new mitral valve.
• Treatment for heart failure. Treatments may include medications (to treat heart failure and manage symptoms, such as with diuretics), placement of a left ventricular assist device (LVAD) or palliative care.
• Treatment for atrial fibrillation. Possible treatments include medications, procedures and surgeries.

There’s no one-size-fits-all approach to treatment. Healthcare providers tailor treatment to your individual needs. They’ll take into account:

• The type of mitral regurgitation you have (primary or secondary).
• The severity of your condition.
• Your risk of surgical complications.

Your provider will explain the benefits and risks of available treatment options. It’s important to ask questions about anything you don’t understand so you can make an informed decision.

Can I prevent mitral valve regurgitation?

It may not be possible to prevent this condition. However, you can work with your healthcare provider to lower your risk for various forms of heart disease. They’ll give you advice tailored to your medical history and risk factors. In general, you can:

• Avoid smoking and all tobacco products.
• Exercise regularly.
• Follow a heart-healthy diet.
• Keep a weight that’s healthy for you.
• Visit your provider for yearly checkups to catch any problems early.
• Visit a provider if you have frequent sore throats with fevers or have been diagnosed with rheumatic fever in the past.

What can I expect if I have this condition?

Many factors influence your outlook, including:

• Your age.
• Whether you have symptoms and how severe they are.
• The severity of regurgitation.
• Whether your valve is repairable.
• The extent of damage to your heart.

Because all of these factors play a role, each person’s situation is unique. Your healthcare provider is the best person to ask about the expected course your condition may take. They know you and your medical history, as well as available treatment options that may help.

How fast does mitral valve regurgitation progress?

Mitral valve regurgitation progresses slowly in some people and more quickly in others. Your healthcare provider can tell you more about the progression of your condition and how often you need to be monitored. They can also tell you how the condition may impact your life expectancy.

When should I see my healthcare provider?

Your healthcare provider will tell you how often you need to come in for exams. The more severe your condition, the more often you’ll need follow-ups and imaging tests. It’s essential to go to all of your appointments. Your provider will monitor your condition and recommend treatment at appropriate times.

What questions should I ask my healthcare provider?

Questions you may want to ask to learn more about your condition include:

• How severe is my mitral regurgitation?
• What treatment options do you recommend for me?
• What are the benefits and risks of treatment?
• What lifestyle changes should I make?
• How often do I need follow-up appointments or imaging tests?
• What’s my outlook?

How common is mitral valve regurgitation?

Mitral valve regurgitation is the most common type of heart valve disease in the U.S. It’s especially common among people as they get older (over age 65).

Mitral regurgitation is the second most common reason for heart valve surgery in Western nations (aortic valve stenosis is the most common).

A note from Cleveland Clinic

Hearing you have a heart condition can stop you in your tracks. But as you learn more about your condition and get treatment, you’ll soon be moving forward again.

Mitral valve regurgitation affects everyone a little differently. Your situation is unique, and your healthcare provider will tailor treatment to your individual needs. Don’t hesitate to share your questions and concerns with your provider. They’ll help you understand more about the inner workings of your heart. They’ll also recommend treatments and lifestyle changes that can help you feel fetter and have the best possible quality of life.