Mitral Valve Regurgitation

What is mitral valve regurgitation?

Mitral valve regurgitation is the backward flow of blood through your heart’s mitral valve. This “door” connects the two chambers on the left side of your heart. It opens and closes when your heart beats. When your mitral valve opens, it lets blood flow from your top left chamber (atrium) down to your bottom left chamber (ventricle). 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 of damage to the door itself (in this case, your valve tissue). Or, damage to the walls and structures surrounding the door (the left chambers of your heart) might keep it from working normally. In either case, your mitral valve can’t fully close. And some blood can leak out.

Doors in your heart can cause minor or serious issues depending on how wide the openings are. A minor leak in your mitral valve might not make much of a difference or cause you to worry. 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.

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).

Types of mitral valve regurgitation

There are two main types of mitral regurgitation:

• Primary mitral regurgitation. In this type, 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 type, the problem is heart disease that affects the heart chambers 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.

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 when you’re resting, lying down, trying to sleep or are physically active.

Other mitral valve regurgitation symptoms can include:

• Having 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 of mitral valve regurgitation may develop gradually or suddenly.

Call 911 or your local emergency number if you have symptoms of acute heart failure. These can happen if your heart is working too hard. Symptoms can come on suddenly and may include:

• Breathing heavily.
• Feeling like you’re suffocating.
• Struggling to breathe while lying down.
• Feeling tightness in your chest.
• Having a low blood oxygen level reading 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 causes mitral valve regurgitation?

Mitral regurgitation happens when your valve fails to close completely. 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 your 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 issue (a heart issue that you have at birth).
• 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 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. A heart murmur may be a sign of valve disease.

Your provider may order tests to get more information.

What tests will be done to diagnose mitral valve regurgitation?

Healthcare providers commonly use transthoracic echocardiogram (TTE) to diagnose mitral valve regurgitation. This painless, noninvasive test can show if you have a leaky valve or other problems with your heart structure or function. If your provider needs to get a closer view of your valve, they can use a transesophageal echocardiogram (TEE).

To assess the severity of the condition or plan treatment, your provider may order additional tests, like:

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

How is mitral valve regurgitation treated?

There’s no one-size-fits-all approach to mitral valve regurgitation treatment. Healthcare providers tailor treatment to your needs. They’ll consider:

• The type of mitral regurgitation you have (primary or secondary).
• The severity of your condition. They may describe it as stage A, B, C or D, with D being the most severe stage.
• 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.

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

Treatment options for mitral valve regurgitation include:

Mitral valve repair

Treatment options for mitral valve repair include:

• Open-heart surgery.
• Minimally invasive heart surgery (using smaller cuts).
• Mitral transcatheter edge-to-edge repair (TEER). Your provider uses a long, thin tube (catheter) to attach a small clip to your valve leaflets. The clip helps the leaflets close more fully.

Mitral valve replacement

Treatment options for mitral valve replacement include:

• 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), a less invasive option.

Treatment for heart failure

Treatments may include:

• Medications like diuretics.
• Placement of a left ventricular assist device (LVAD).
• Palliative care.

Treatment for atrial fibrillation

Possible treatments include:

• Medications.
• Procedures.
• Surgeries.

Can mitral valve regurgitation be prevented?

It may not be possible to prevent this condition, but 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 using all tobacco products.
• Get regular physical activity.
• Eat heart-healthy foods.
• 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 mitral valve regurgitation?

Many factors affect 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, your 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 they need to monitor you. They can also tell you how the condition may impact your life expectancy.

How do I take care of myself?

It’s always a good idea to manage your blood pressure and eat lots of fruits and vegetables.

Cardiac rehab after heart valve surgery can help you get back to physical activity. Mitral valve regurgitation management includes taking medicine after you get a new artificial valve. You’ll need to take anticoagulants for the rest of your life to prevent blood clots. You’ll also need to take antibiotics before dental appointments or upper respiratory tract procedures. This prevents endocarditis.

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?

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, and your healthcare provider will tailor treatment to your 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 better and have the best possible quality of life.