Mitral Valve Disease

What is mitral valve disease?

Mitral valve disease refers to a group of conditions affecting the mitral valve in your heart. Mitral valve disease can be acquired (it develops over time as you get older) or congenital (you were born with it). It can be mild, moderate or severe. Treatment depends on how well your valve is working and the symptoms you’re having.

Your mitral valve lets blood flow from your left atrium to your left ventricle. These two chambers of your heart hold oxygen-rich blood from your lungs and pump that blood out to your body. When your mitral valve becomes diseased or damaged, it can’t work as well as it should. Mild damage may cause no symptoms and no major problems. But severe damage to your mitral valve can harm your heart over time and lead to serious problems like heart failure.

Heart valve disease refers to problems with any of your heart’s four valves. Some people with mitral valve disease also have problems with other valves in their hearts. It’s also possible to have valve disease along with other cardiovascular problems, like coronary artery disease.

Mitral valve disease can take different forms, and some people may have more than one form.

What are the different forms of mitral valve disease?

Mitral valve disease has three different forms. Each form affects your valve’s function in a slightly different way. To understand these differences, it’s important to know the basic structure of your mitral valve.

Your mitral valve is made of two strong flaps of tissue called leaflets or cusps. These flaps open and close in a coordinated rhythm to let blood flow out of your left atrium and into your left ventricle. They’re like traffic directors that let a few cars through at a time, then pause traffic, then let more cars through.

Mitral valve disease causes these flaps to be less efficient traffic directors. Instead of letting three cars go through, they may only let one or two. Or, they may let three cars through but then force one to go in reverse so it’s back where it started.

Your blood needs to flow through your heart efficiently. And it needs to keep moving forward in the right direction. Mitral valve disease can slow down your blood flow or cause it to leak in the wrong direction, depending on the form.

The three forms of mitral valve disease include:

• Mitral valve stenosis. Your valve’s flaps become thick and stiff. This narrows the valve opening and makes it harder for blood to get through.
• Mitral valve prolapse. Your valve’s flaps become too stretchy and bulge into your left atrium. This prevents your valve from closing as well as it should. It sometimes leads to regurgitation (leaky valve).
• Mitral valve regurgitation. This is commonly known as a leaky valve. It’s also sometimes called “mitral insufficiency.” Your valve’s flaps become pulled apart and can’t close all the way. So, some blood leaks backward into your left atrium.

Who does mitral valve disease affect?

Mitral valve disease affects people of all ages. Some babies are born with mitral valve problems. Some adults are affected suddenly due to an infection in their heart or a heart attack. Usually, though, adults develop mitral valve disease over time as the valve slowly deteriorates.

One form, mitral valve prolapse, is more common among women. However, mitral valve prolapse seems more dangerous for men. They’re more likely to have prolapse that leads to severe regurgitation.

How common is mitral valve disease?

Some forms of mitral valve disease are more common than others.

About 1 in 100,000 people in the U.S. have mitral valve stenosis. It’s the least common form in the U.S. It’s more common in other countries with higher rates of rheumatic fever (a major cause of mitral stenosis).

Mitral valve prolapse is more common. It affects as many as 1 in 33 people in the U.S, but not all people with mitral valve prolapse develop significant valve leaks.

Mitral valve regurgitation is also common. About 1 in 10 people in the U.S. have a leak in one of their valves. Among those cases, most people have a leaky mitral valve.

What are the symptoms of mitral valve disease?

The symptoms of mitral valve disease depend on the form you have. In some cases, symptoms also depend on the severity of the disease.

You may have no symptoms at all. If you do have symptoms, they can include:

• Chest pain.
• Cough.
• Coughing up blood.
• Dizziness or fainting.
• Fatigue.
• Heart palpitations. These can feel like bursts of rapid heartbeat or an awareness of your heartbeat.
• Migraines.
• Mitral facies. This is a plum-colored flush in your cheeks.
• Orthostatic hypotension. This is blood pressure that gets too low when you stand up.
• Shortness of breath.
• Swelling in your legs, ankles or feet.

Other conditions like atrial fibrillation and heart failure also can affect your symptoms.

What causes mitral valve disease?

There are many possible causes for mitral valve disease. These include:

• Congenital heart defect. Some people are born with mitral valve disease. It may be mild or severe. Babies with life-threatening defects need surgery right away.
• Connective tissue disorders. These include Marfan syndrome and Ehlers-Danlos syndrome.
• Endocarditis. This is an infection in your heart.
• Enlargement of your left ventricle, usually due to a heart attack or cardiomyopathy.
• Getting older. As we age, calcium can slowly build up on our heart valves. For many people, this buildup only causes mild or moderate mitral valve stenosis.
• Radiation therapy. People who had radiation to their chest have a higher risk of heart valve damage. These issues usually don’t show up until 10 to 20 years later.
• Rheumatic fever. This infection, when untreated, can lead to heart valve damage. The damage can show up years or decades after the infection. Rheumatic fever is the most common cause of mitral valve stenosis, especially among people born before 1943. Modern use of antibiotics to treat bacterial infections has greatly reduced this problem in the U.S. and many other countries.

How is mitral valve disease diagnosed?

Mitral valve disease is diagnosed through a physical exam and tests.

Physical exam

During the physical exam, your provider will listen to your heart with a stethoscope. Your provider will check to hear certain sounds associated with each form of mitral valve disease.

• Mitral valve stenosis: A murmur as blood passes through and a snapping sound when your valve opens.
• Mitral valve prolapse: A clicking sound and then a murmur. Because of this distinctive sound, mitral valve prolapse is also called “click-murmur syndrome.”
• Mitral valve regurgitation: A murmur as blood leaks the wrong way into your left atrium.

Your provider will also talk with you to learn about your medical history and risk factors.

You’ll then likely need at least one test to check your heart’s structure and function.

Tests to diagnose mitral valve disease

Echocardiography is the gold standard for diagnosing mitral valve disease. An echocardiogram (echo) uses ultrasound technology to check for valve disease and other heart problems.

Your provider may also recommend other tests to get a fuller picture of how your heart is working. These include:

• Electrocardiography (ECG/EKG). An ECG shows your heart’s electrical activity.
• Chest X-ray. This test will show if your left ventricle is enlarged or if fluid is building up in your lungs.
• Cardiac catheterization. This test measures pressures within your heart and can show if you have mitral valve stenosis. Cardiac catheterization is also used before surgery to check for coronary artery disease.

How do you treat mitral valve disease?

Treatment for mitral valve disease depends on your symptoms. If you don’t have any symptoms, you may not need treatment. If you do have symptoms and need treatment, your provider will discuss your options with you.

Treatment options for mitral valve disease include:

• Balloon valvotomy. This catheter-based procedure treats mitral valve stenosis. It separates the cusps (flaps) of your mitral valve using a balloon. A catheter with a balloon at its tip is guided through your blood vessels until it reaches your heart. When the balloon reaches your valve, it’s inflated to create more room between the cusps.
• Medication. Your provider may prescribe drugs that ease some of your symptoms. These drugs include diuretics, beta-blockers and calcium channel blockers. They can help you manage your blood pressure, reduce swelling, and slow down your heart rate if it’s too fast. Your provider may also recommend blood thinners to lower your risk of blood clots.
• Mitral valve repair surgery. Most doctors prefer this method over replacement surgery whenever possible. It allows you to keep your valve and avoid some of the complications that come with valve replacement.
• Mitral valve replacement surgery. Sometimes replacing your valve is necessary. Your provider will discuss the benefits and risks with you.
• Minimally invasive mitral valve repair. Minimally invasive methods allow for smaller incisions and a quicker recovery. Methods include a right mini-thoracotomy, partial upper sternotomy and robotically-assisted repair.
• Percutaneous interventions. These catheter-based procedures are often a good fit for people who have an enlarged heart, a weak heart or other health problems. If you have mitral valve regurgitation, you may be a candidate for a MitraClip™ device. This dime-sized device can be implanted on your mitral valve to help it close better and prevent your blood from flowing backward.
• Percutaneous mitral valve replacement. In some cases where surgery would be high risk and it’s anatomically feasible, surgeons will expand a new valve inside of a diseased mitral valve.

Talk with your provider about the treatment option that’s best for you. Many factors affect your treatment plan, including:

• What form of mitral valve disease you have.
• Your age.
• Your health history.
• Your current health condition.
• Whether you have other heart issues that need to be repaired at the same time.

Complications of mitral valve treatment

Surgeries and procedures to treat mitral valve disease are generally very successful. The risk of complications is low. Possible complications are similar to those for other heart procedures, and include:

• Arrhythmia.
• Bleeding.
• Blood clots.
• Heart attack.
• Heart block.
• Infection.

Risks vary based on the type of treatment you have and other factors, like whether you have coronary artery disease. Talk with your provider about the risks of your specific surgery or procedure.

Can mitral valve disease be prevented?

In many cases, valve diseases can’t be prevented. But there are some actions you can take to lower your chances of developing valve disease as you get older. These include:

• Keep a healthy weight to support the health of your heart and blood vessels.
• Take prescribed antibiotics for strep throat or scarlet fever. Make sure to follow the instructions for how long you need to take the antibiotics.
• Visit your healthcare provider for a checkup each year.

If you’re pregnant or planning a pregnancy, talk with your provider about what you can do to lower your baby’s risk for congenital heart defects. Your provider will likely advise you to avoid:

• Smoking and/or tobacco use and secondhand smoke.
• Alcohol.
• Recreational drugs, especially cocaine.

Be sure to talk with your provider about any prescription medications you’re taking and how those might affect your pregnancy.

Genetic testing may be a good idea if you have a family history of congenital heart disease or connective tissue disorders.

How long can you live with mitral valve disease?

The life expectancy for people with mitral valve disease depends on many factors. These include:

• What form of mitral valve disease you have.
• How severe the disease has become.
• How much the disease has harmed your heart.
• When you receive treatment.

Talk with your provider about what to expect in your situation.

When should I see my healthcare provider?

See your provider right away if you have any symptoms of mitral valve disease. Catching problems early can help you avoid serious complications later on.

Your provider may ask you to come back for routine visits. These may be to monitor a valve problem that is mild, or to follow up on your valve repair or replacement. It’s important to keep all these appointments.

When to seek emergency care

Call 911 or your local emergency number if you experience:

• Chest pain.
• Fainting, dizziness or extreme weakness.
• Fast or irregular heartbeat.
• Sudden and severe shortness of breath.
• An unexpected side effect from your medication.

If you’re on blood thinners (anticoagulants) and fall, you should also seek care right away. Blood thinners raise your risk of internal bleeding, especially after you fall. You might feel fine, but you still should get checked to make sure you don’t have internal bleeding. It can be fatal.

What questions should I ask my provider?

If you’ve been diagnosed with mitral valve disease, the next step is to learn more about your condition. Mitral valve disease can range from very mild to very severe. Your provider will tailor treatment to your needs. So, it’s helpful to learn about the severity of your valve disease, whether you need treatment and what your treatment options would be.

Ask your provider:

• How severe is my condition?
• Can it get worse over time?
• Do I need surgery? If so, when?
• Am I a candidate for a minimally invasive or catheter-based procedure?
• Can my valve be repaired, or do I need a new valve?
• What can I expect during the treatment process?
• What are the risks of this form of treatment? What are the benefits?
• What’s the recovery like?
• How often should I come back for follow-ups?
• Do I need to take any medications now or after treatment? For how long?
• What lifestyle changes should I make?

It’s also a good idea to learn more about who would perform your surgery or procedure. Consider asking:

• Who would perform my surgery or procedure?
• How often do they perform this surgery or procedure?
• What’s the success rate?

Valve repair is complex. It’s important to find an experienced specialist who can manage the unique details of your specific case.

How should I take care of myself?

Your provider will tell you how to manage your specific condition. In general, it’s important to:

• Take your medications as prescribed.
• Take care of your teeth and gums.
• Follow your provider’s guidance on how often to exercise, and how intensely.
• Avoid smoking, alcohol and recreational drugs.
• Manage stress.
• Get enough sleep.

This may feel like a lot to handle at once. Talk with your provider about resources that can help you make lifestyle changes at a reasonable pace.

Update your emergency medical information card

If you have any form of valve disease, it’s important to tell all your healthcare providers including your dentist. You may need to take antibiotics before certain dental or medical procedures.

It’s also important to update your medical information card (and create one if you don’t have one). This is a card you carry with you at all times that lists:

• Your full name and date of birth.
• At least one emergency contact.
• Contact information for your main healthcare provider.
• Allergies.
• All medications you’re taking.

You should add to your card:

• What form of valve disease you have.
• Whether you’ve had repair or replacement.
• Whether you’re on blood thinners.

Talk with your provider about how to create or update your card if this is new to you. You can start by writing this information on a simple index card and keeping it in your wallet or purse.