Mitral Valve Regurgitation (Mitral Valve Insufficiency)

Mitral valve regurgitation, also known as mitral valve insufficiency or mitral valve incompetence, is the most common form of heart valve disease. An estimated 4 million people in the U.S. have significant mitral valve regurgitation. About one in 10 people age 75 and older have mitral valve regurgitation.

What is mitral valve regurgitation?

The function of the four heart valves is to direct flow of blood through the heart. The mitral valve is a one-way valve that separates the left atrium, the heart chamber that receives blood from the lungs, from the left ventricle, the heart chamber that pumps oxygen-rich blood to the body. When the left ventricle squeezes, the mitral valve closes to prevent blood from traveling backwards and re-entering the left atrium and subsequently the lungs. When the two flaps or leaflets of the mitral valve do not close properly, mitral valve regurgitation occurs. Mitral valve regurgitation is in essence, an incompetent or leaky mitral valve.

Mitral valve regurgitation causes

Although there are many causes of mitral regurgitation, the two most common types are functional mitral regurgitation (where the left ventricle is enlarged and pulls the mitral leaflets away from each other preventing normal closure) and degenerative mitral regurgitation (mitral valve prolapse).

Following are some of the causes of mitral valve regurgitation:

  • weakened heart muscle
  • mitral valve prolapse
  • heart valve infection
  • rheumatic heart disease or mitral valve stenosis

Mitral valve regurgitation symptoms

When mitral regurgitation is severe, the blood backs up into the lungs. This leads to congestive heart failure, which causes fatigue, fluid retention and shortness of breath. Additionally, the leakiness of the valve burdens the heart and causes it to work harder. Eventually the heart becomes weakened and enlarged.

Following are common symptoms of mitral regurgitation. Symptoms will vary depending on the severity of the condition and how long it has been developing:

  • fatigue
  • shortness of breath
  • swollen feet or ankles
  • rapid, fluttering of heartbeat (heart palpitations)
  • cough, especially when lying down
  • heart murmur

Mitral valve regurgitation diagnosis

The following tests may be ordered to diagnose mitral regurgitation:

  • transthoracic echocardiogram (TTE)
  • transesophageal echocardiogram (TEE)
  • cardiac catheterization 

Mitral valve regurgitation treatment

Treatment options for mitral regurgitation may include medication, catheter-based procedure, minimally invasive valve surgery or open-heart surgery. A specific treatment will be determined by your doctor based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your signs and symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Medications

Mitral valve regurgitation cannot be corrected with medication, but it may be prescribed to relieve or control the symptoms. Medications may include:

  • beta-blockers to monitor heart rate
  • blood thinners to help prevent blood clots for atrial fibrillation patients
  • diuretics to relieve fluid accumulation
  • high blood pressure (hypertension) medications to keep the patients high blood pressure within normal ranges

Catheter-based procedure

Some patients may benefit from catheter-based procedures like the MitraClip, which is a catheter treatment option for high-risk mitral valve regurgitation patients. This procedure can significantly reduce symptoms and improve quality of life. Beaumont was one of the few hospitals in Michigan who participated in the MitraClip research study and was the first hospital in Michigan to implant the FDA approved device in 2013.

Minimally Invasive or Full-Sternotomy Procedures

Some patients may be recommended for a surgical approach. Beaumont's cardiac surgeons can repair or replace a mitral valve using minimally invasive heart surgery through a small two to three-inch incision. This means less pain and shorter recovery for the patient. Some patients may undergo a full sternotomy (open-chest incision) to repair or replace the mitral valve. These different techniques are proven and effective way of eliminating mitral regurgitation and improving symptoms of heart failure.