What is mitral valve regurgitation?

When the mitral valve becomes leaky, it's called mitral valve regurgitation. It’s also known as mitral insufficiency. The mitral valve is 1 of the heart’s 4 valves. These valves help the blood flow through the heart’s 4 chambers and out to the body. The mitral valve lies between the left atrium and the left ventricle. Normally, the mitral valve prevents blood flowing back into the left atrium from the left ventricle. But in mitral valve regurgitation, some blood leaks back through the valve. It doesn’t just flow forward into the ventricle the way it should. Because of this, the heart has to work harder than it should to get blood out to the body. If the regurgitation gets worse, some blood may start to back up into the lungs. A very small amount of mitral regurgitation is common. But some people have severe mitral valve regurgitation.

Mitral valve regurgitation can be acute or chronic. With the acute condition, the valve suddenly becomes leaky. In this case, the heart doesn’t have time to adapt to the leak in the valve. Symptoms with acute mitral regurgitation are often severe. In the chronic form, the valve gradually becomes leakier over time. This gives the heart time to adapt to the leak. With chronic mitral regurgitation, the symptoms may range from mild to severe.

What causes mitral valve regurgitation?

A range of conditions can cause mitral valve regurgitation. They include:

• Floppy mitral valve (mitral valve prolapse)
• Rheumatic heart disease from untreated infection with strep bacteria
• Coronary artery disease or heart attack
• Certain autoimmune diseases such as rheumatoid arthritis
• Infection of the heart valves (endocarditis)
• Heart problems present at birth (congenital)
• Support structures of the mitral valve break (rupture)
• Certain medicines
• Abnormal function of the heart muscle (cardiomyopathy)
• Trauma

Acute mitral valve regurgitation is more likely to happen after a heart attack. It’s also more likely to happen after rupture of the tissue or muscle that supports the mitral valve. It can happen after an acute injury or heart valve infection.

Who is at risk for mitral valve regurgitation?

You are more likely to have mitral valve regurgitation if you:

• Don't get treated for a strep infection and develop rheumatic heart disease
• Use IV drugs. These raise the risk for heart valve infection.
• Don't get prompt treatment for health conditions that can lead to the disorder

Some risk factors you can’t change. For example, some conditions that can lead to mitral valve regurgitation are partly genetic.

What are the symptoms of mitral valve regurgitation?

Most people with chronic mitral valve regurgitation don’t notice any symptoms for a long time. People with mild or moderate mitral regurgitation often don’t have any symptoms. If the regurgitation becomes more severe, symptoms may start. They may be stronger and happen more often over time. They may include:

• Shortness of breath with exertion
• Shortness of breath when lying flat
• Tiredness (fatigue)
• Reduced ability to exercise
• Unpleasant awareness of your heartbeat
• Palpitations
• Swelling in your legs, abdomen, and the veins in your neck
• Chest pain (less common)

Acute, severe mitral valve regurgitation is a medical emergency. It can cause serious symptoms such as:

• Symptoms of shock, such as pale skin, loss of consciousness, or rapid breathing
• Severe shortness of breath
• Abnormal heart rhythms that make the heart unable to pump well

How is mitral valve regurgitation diagnosed?

Your healthcare provider will take your health history and give you a physical exam. Using a stethoscope, your provider will check for heart murmurs and other signs of the condition. You may also have tests such as:

• Echocardiogram to assess severity
• Stress echocardiogram to assess exercise tolerance
• Electrocardiogram (ECG) to assess heart rhythm
• Cardiac MRI
• Transesophageal echocardiogram
• Cardiac catheterization

How is mitral valve regurgitation treated?

Treatment varies depending on the cause for the condition. It also varies depending on how severe and sudden the condition is. And it depends on your overall health. Mitral valve regurgitation can increase risk for other heart rhythm problems such as atrial fibrillation.

If you have mild or moderate mitral valve regurgitation, you may not need any treatment. Your healthcare provider may just choose to watch your condition. You may need regular echocardiograms over time if you have moderate mitral valve regurgitation. Your healthcare provider might also prescribe medicines such as:

• Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers to help reduce the workload of the heart when a person’s pump function is not working as well
• Medicines to slow the heart rate if you develop atrial fibrillation
• Water pills (diuretics) to reduce swelling and improve symptoms
• Blood thinners (anticoagulants) to help prevent blood clots if you have atrial fibrillation

Surgery may be needed with severe mitral valve regurgitation. Surgery is often needed right away for acute severe mitral valve regurgitation. The surgeon may be able to repair the mitral valve. In some cases, a replacement valve is needed. Your surgeon might use a valve made of pig, cow, or human heart tissue. Artificial mechanical valves are another option. Talk with your surgeon about which one is right for you. Your surgeon might do open surgery or a minimally invasive repair. If you have atrial fibrillation, the surgeon may do a Maze procedure. This is a type of heart surgery that can reduce the future risk of atrial fibrillation. In some cases, a clip can be used to reduce the amount of mitral regurgitation. This can eliminate the need for surgery or delay it. Moderate or severe mitral regurgitation can cause problems during pregnancy. Valve surgery may be needed before a person becomes pregnant.

What are possible complications of mitral valve regurgitation?

Mitral valve regurgitation can cause complications such as:

• Atrial fibrillation, in which the atria of the heart don’t contract well. This leads to increased risk of stroke.
• Elevated blood pressure in the lungs (pulmonary artery hypertension)
• Dilation of the heart
• Heart failure
• Bacterial infection of the heart valves. This is more likely after valve replacement surgery.

To reduce the risk of these complications, your healthcare provider may prescribe:

• Blood-thinning medicine that prevents blood clots
• Medicines to reduce the stress load of the heart
• Antibiotics before certain medical and dental procedures. In most cases, you will only need antibiotics if you have had valve surgery or a previous bacterial infection of the heart valves.

Living with mitral valve regurgitation

You'll need to see your healthcare provider for regular monitoring. See your healthcare provider right away if your symptoms change. Note your symptoms when exercising. Symptoms may get worse during physical activity. Talk with your provider about your exercise program and what is right for you. If you have progressive mitral regurgitation, your healthcare provider may advise against competitive sports. Tell all your healthcare providers and dentists about your medical history.

Your healthcare provider may want to treat you for heart problems related to mitral valve regurgitation. Treatments may include:

• A low-salt, heart-healthy diet (to decrease blood pressure and the stress on your heart)
• Blood pressure lowering medicines
• Medicines to reduce the risk of arrhythmias
• Reduction of caffeine and alcohol to reduce risk of arrhythmias

When should I call my healthcare provider?

If you notice your symptoms are slowly getting worse, plan to see your healthcare provider. You may need surgery or a medicine change.

See your healthcare provider right away if:

• You have severe shortness of breath or chest pain
• You notice sudden new symptoms

Key points about mitral valve regurgitation

• With mitral valve regurgitation, the heart’s mitral valve is leaky. Some blood flows back into the left atrium from the left ventricle.
• You may not have symptoms for many years.
• Chronic mitral valve regurgitation may get worse and need surgery.
• Acute, severe mitral valve regurgitation is a medical emergency. It needs surgery right away.
• See your healthcare provider for regular checkups to monitor your condition. If your symptoms get worse or become severe, see your healthcare provider right away.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Having Open Mitral Valve Replacement

The mitral valve allows blood to flow from the left atrium to the left ventricle in the heart. A mitral valve replacement is a surgery to replace a mitral valve that doesn’t work well. It’s replaced with a new valve. Open heart surgery is a procedure for mitral valve repair. It’s done with a cut (incision) in the middle of the chest that goes through your breastbone.

Choosing a new valve

Before the surgery, you and your healthcare provider will talk about what kind of valve will work best for you. You may be given a biological valve. This is a valve made from animal or human heart tissue. Or you may be given a mechanical valve. This is an artificial valve made from metal and other materials.

Each type of valve has different risks and benefits. Biological valves need to be replaced in 10 to 20 years. Mechanical valves are more durable and can last for a very long time, but you need to take blood thinner medicine for life. This is to help prevent clots that can form on the valve and may cause stroke or the working part of the valve to become frozen and nonworking. Talk with your provider about the kinds of follow-up care needed for each type.

What to tell your healthcare provider

Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements or illegal drugs. And tell your provider if you:

• Have had any recent changes in your health, such as an infection or fever

• Are sensitive or allergic to any medicines, latex, tape, or anesthesia (local and general)

• Are pregnant or think you may be pregnant

Tests before your surgery

Before your surgery, you may need tests such as:

• Chest X-ray

• Electrocardiogram (ECG), to check the heart’s rhythm

• Blood tests, to look at your general health

• Echocardiogram, to view heart anatomy and blood flow through the heart

• Coronary angiogram, to look at blood flow in your heart’s arteries

Getting ready for your surgery

Talk with your healthcare provider about how to get ready for your surgery. You may need to stop taking some medicines before the surgery, such as blood thinners and aspirin. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Also, make sure to do the following:

• Ask a family member or friend to take you home from the hospital. Don't drive yourself.

• Follow any directions you're given for not eating or drinking before surgery.

• Follow all other instructions from your healthcare provider.

You'll be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully. Ask questions if something isn't clear.

On the day of surgery

Your procedure will be done by a cardiac surgeon. This is a doctor who treats diseases of the heart. They will work with a team of specialized nurses and operating room staff. The surgery will take several hours. In general, you can expect the following:

• You will have general anesthesia, which is medicine that allows you to sleep through the surgery. You won’t feel any pain during the surgery.

• An anesthesiologist will give you the general anesthesia and will watch your vital signs, like your heart rate and blood pressure, during the surgery.

• You will be hooked up to a heart-lung machine. This machine will act as your heart and lungs during the surgery.

• The surgeon makes a cut (incision) down the middle of your chest. To reach your heart, the surgeon separates the breastbone.

• The surgeon takes out your mitral valve. They replace it with a new valve.

• The surgery team takes you off the heart-lung machine.

• The team wires your breastbone back together. They close the incision in your chest with stitches, staples, or both. The team puts dressings on the incisions.

After your surgery

After surgery, you'll be taken to a recovery room or directly to the intensive care unit (ICU). Nurses will check your breathing, heart rate, and blood pressure. You may have a tube draining fluid from your chest. You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. The tube is usually removed within 24 hours. You may stay in the hospital for about 5 days.

You may have some pain at the incision site after surgery. You can take pain medicines to help relieve it. Only take pain medicine approved by your healthcare provider.

In a day or two, you should be able to sit in a chair and walk with help. You may need to do breathing therapy to help prevent or remove fluid building up in your lungs. You can go back to your normal food as soon as you feel able.

Make sure you have someone to help at home for a while. When you go home, it may take a little while for you to resume normal activities. Don't do any vigorous exercise until your healthcare provider says you are ready. Don't get the incision wet until your healthcare provider gives you permission to do so. Don’t lift anything heavy until your healthcare provider says it’s OK. Ask your healthcare provider when it is safe for you to drive.

Take your temperature and weigh yourself every day. This is to check for infection, and to make sure your heart is pumping normally. If it doesn’t pump normally, fluid can build up in your body and quickly cause you to gain excess weight.

Follow-up care

You will likely have your stitches or staples removed in 7 to 10 days. Make sure you keep all of your follow-up appointments. Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

Make sure all your dentists and doctors know about your new heart valve. You may need to take antibiotics before certain medical and dental procedures. This is to prevent getting an infection in your new valve.

If you have a mechanical valve, you will need to take blood thinner medicine. This is medicine that helps prevent clots. Blood thinners require frequent monitoring of levels, and certain foods and medicines can interact with these drugs. Make sure you know all about the blood thinners you are prescribed before you leave the hospital. 

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as directed by your provider

• Increase in pain, redness, bleeding, or fluid leaking from the incision

• Sudden change in weight

• Other symptoms as advised