Mitral Valve Regurgitation
The mitral valve controls blood flow between the heart's upper and lower chambers on the left side. In a healthy heart, the valve's two leaflets – flaps that open and shut like a double door – form a tight seal each time they close, which keeps the blood moving in the right direction. In mitral valve regurgitation, the flaps don't seal well, which allows blood to leak backward and forces the heart to work harder to pump blood out to the body. This can cause shortness of breath and fatigue. If the backflow, or regurgitation, is severe enough, the heart may enlarge over time as a way to maintain blood flow, and this can lead to pulmonary hypertension (high blood pressure in the lungs) and heart failure.
At the UCSF Heart Valve Disease Clinic, interventional cardiologists and cardiothoracic surgeons provide comprehensive care for mitral valve regurgitation. Our experts offer the full range of treatments, from medications to minimally invasive valve repair or replacement to open-heart surgery.
Mitral valve regurgitation can be caused by a problem with the valve itself, a condition called primary mitral valve regurgitation. The problem may be a birth defect, damage from rheumatic fever or – most commonly – deterioration of the valve flaps that occurs with aging.
In secondary (or functional) mitral valve regurgitation, the condition is caused by coronary artery disease (narrowing of the heart's arteries) or cardiomyopathy (diseases of the heart muscle).
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Signs & symptoms
Symptoms range widely because they depend on how well the valve is working. If the regurgitation is mild to moderate, people can have the condition for years without experiencing problems. But if the condition is advanced or develops rapidly, symptoms may be severe.
Symptoms may include:
- Shortness of breath with exertion
- Shortness of breath when lying down
- 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
The team of specialists at our Heart Valve Disease Clinic works collaboratively to evaluate each patient and determine the best treatment plan for meeting individual needs. To diagnose mitral valve regurgitation and determine its severity, doctors may order some of the following tests:
- Blood tests measure a variety of health-related factors, such as red blood cell numbers and electrolyte levels (amounts of elements, such as sodium and potassium, in the blood). 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-rays show the size of the heart and may reveal fluid buildup in the lungs.
- Electrocardiogram (EKG) is a painless test used to detect enlarged heart chambers, heart disease and abnormal heart rhythms. Adhesive electrodes are placed on the skin; wires connect them to a monitor that records the heart's electrical activity.
- Transesophageal echocardiogram (TEE) is a heart ultrasound in which clear images of the heart's chambers, valves and blood flow are obtained by passing the transducer (the device emitting sound waves) into the esophagus. A TEE can also show whether blood clots are forming in the pumping heart.
- Cardiac catheterization (coronary angiogram) may be used to assess severity of the valve leakage and rule out associated coronary artery disease, particularly in older patients. The doctor threads a catheter (a thin, flexible tube) through a blood vessel in the wrist or groin to an artery in the heart, and injects a harmless dye that makes the artery visible on X-rays. These detailed images of the heart provide information on its functional and structural health. Tiny instruments passed through the catheter can measure the pressure inside the heart chambers.
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 the regurgitation is more of a problem, you may need to have the valve repaired or replaced. Depending on your heart's condition and your overall health, the doctor will recommend one of the following procedures:
- Open-heart surgery to repair or replace the diseased valve may be required for severe mitral valve regurgitation that develops or worsens abruptly. The replacement is 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 can be an option for patients who have regurgitation but no other serious heart problems. The surgeon repairs the valve using a tiny camera and specialized instruments that can 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 is a minimally invasive procedure in which a catheter is threaded through a blood vessel to the mitral valve in order to deliver a device that reduces the backflow of blood. The MitraClip is implanted across the valve's two flaps, which helps them close more securely. Sometimes more than one clip is required. The procedure doesn't require making incisions in the chest or temporarily stopping the heart.
- Transcatheter mitral valve replacement may be recommended for certain 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 by means of 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. Because this is not a standard treatment, potential recipients may need to undergo further evaluation, such as a CT scan or other procedures.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.