In mitral valve regurgitation, the left atrium valve does not close properly, allowing blood to flow backward into the left atrium. In addition to fatigue, shortness of breath, palpitations, and swelling, this can reduce the amount of blood pumped into the body. There are a variety of factors that can cause mitral valve regurgitation, including damage to the valve, congenital defects, infections, rheumatic fever, and calcium buildup. A healthy lifestyle and regular checkups can prevent mitral valve regurgitation. Treatment options may include medications, surgery, or catheter procedures to repair or replace the valve.
The mitral valve is one of the four valves in the heart that regulate the flow of blood between the chambers. The valve has two flaps (leaflets) that open and close to allow blood to pass from the left atrium to the left ventricle. When the heart contracts, some blood leaks back into the left atrium because the leaflets do not seal tightly. It can reduce the efficiency of the heart and increase lung and left atrium pressures.
Mitral valve regurgitation is divided into two types: primary and secondary. Primary mitral valve regurgitation occurs when there is a problem with the valve itself, such as:
When the leaflets are too stretchy or have extra tissue, they bulge backward into the left atrium, causing primary mitral valve regurgitation.
The structure or function of a valve is affected by congenital defects.
Usually caused by bacteria, infectious endocarditis is an infection of the inner lining of the heart or the valves.
Untreated strep throat can result in rheumatic fever, which damages the heart's valves and other parts.
A calcium buildup can narrow and harden the valve, preventing it from closing properly.
A secondary mitral valve regurgitation occurs when there is an issue with the heart muscle or surrounding structures that affects the valve's function, such as:
During a heart attack, the heart muscle can be damaged and its ability to contract and pull the valve leaflets together can be compromised.
In heart failure, the heart cannot pump enough blood to meet the body's needs, causing the heart to enlarge and stretch the valve openings.
The disease cardiomyopathy affects the shape, size, and function of the heart muscle.
The heart and valves can be stressed by high blood pressure.
Mitral valve regurgitation can be caused by a number of factors, including:
Mitral valve disease or other heart valve disorders in the family
As the valve ages, it can wear out or degenerate
As women are more likely to suffer from mitral valve prolapse than men,
Diseases that affect the elasticity and strength of the valve tissue, such as Marfan syndrome or Ehlers-Danlos syndrome
Coronary artery disease, atrial fibrillation, and congenital heart defects are other heart conditions
There are many people who have mitral valve regurgitation without any symptoms and are unaware of their condition. However, severe or acute regurgitation may cause the following signs and symptoms:
The heart has to work harder to pump blood to the body, causing fatigue or weakness
Blood backs up into the lungs during exertion or when lying down, causing fluid accumulation in the lungs
There may be palpitations or irregular heartbeats due to valve leakage or increased pressure in the left atrium, which may affect the heart rhythm
Heart muscle does not receive enough oxygen-rich blood, resulting in chest pain or discomfort similar to angina or a heart attack
Fluid retention in the lungs may affect circulation in the lower extremities, resulting in swollen feet and ankles
Due to the reduced cardiac output, lightheadedness or fainting may occur
Some factors, such as stress, physical activity, cold weather, caffeine, alcohol, or certain medications, may trigger or worsen the symptoms of mitral valve regurgitation.
An echocardiogram, an ultrasound of the heart and the valves that shows the structure and function of the heart and the valves, is usually used to diagnose mitral valve regurgitation. An echocardiogram can confirm the diagnosis, determine the severity, and assess the risk of complications. It can also measure the size and pressure of the left atrium as well as the left ventricle.
Mitral valve regurgitation may also be evaluated by the following tests:
Check for signs of fluid accumulation or enlargement of the heart or lungs with a chest X-ray
The electrocardiogram (ECG or EKG) measures the electrical activity of the heart and detects arrhythmias or signs of heart disease
Imaging with magnetic resonance (MRI) to determine the extent of regurgitation and its effect on the heart's function and provide detailed images of the heart and valve
Examine the blood vessels that supply the heart for blockages or coronary artery disease with a coronary angiogram
Symptoms, cause, and severity all contribute to the treatment of mitral valve regurgitation. It may not be necessary to treat mild or moderate regurgitation in some people, but they should follow a healthy lifestyle and visit their doctor regularly. It may be necessary to take medications to treat symptoms or prevent complications. The valve may need to be repaired or replaced with surgery or a catheter procedure if the regurgitation is severe or symptomatic.
Mitral valve regurgitation can be treated in several ways:
Medications that can relieve symptoms and reduce complications include:
The diuretics can help remove excess fluid from the lungs and body and reduce heart and lung pressure
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which can lower blood pressure and heart workload
Heart rate and contraction force can be slowed with beta blockers, which reduce oxygen demand in the heart
Anticoagulants or antiplatelets, which prevent blood clots from forming and reduce stroke and embolism risks
Atrial fibrillation and other arrhythmias can be prevented with antiarrhythmics
There are a number of surgical procedures that can be used to repair or replace a damaged valve and restore normal blood flow, including:
In order to prevent leaks and improve valve function, valve repair involves tightening or reshaping the valve leaflets or ring (annulus). It is usually preferable to repair a valve rather than replace it, since it preserves the valve and lowers complications.
Replacement of the diseased valve occurs when it is too damaged or calcified to be repaired. It involves removing the diseased valve and replacing it with an artificial one made of metal, plastic, or animal tissue. There are, however, some disadvantages to replacing a valve, including the requirement for lifelong anticoagulation therapy for mechanical valves and the possibility of infection or degeneration for biological valves.
The catheter procedure is a less invasive alternative to surgery in which a thin tube (catheter) is inserted through a blood vessel to access the heart and the valves, such as:
Some patients with primary mitral valve regurgitation due to mitral valve prolapse can benefit from mitral valve clip, which involves attaching a small metal clip to the leaflets to reduce regurgitation.
TMVR (transcatheter mitral valve replacement) involves implanting a new valve inside the old one using a catheter. This procedure is still experimental, but may be an option for people with secondary mitral valve regurgitation.
A person's choice of treatment depends on several factors, such as their age, health, and preferences, the severity and cause of the regurgitation, their symptoms, and the doctor's availability and expertise.
In order to reduce the risk of developing or worsening mitral valve regurgitation, some steps can be taken, including:
The consumption of fruits, vegetables, and whole grains as part of a balanced diet low in salt, fat, and cholesterol
Regular exercise, but avoid strenuous activities that can strain the heart or valves
Smoking damages the heart and blood vessels and increases the risk of heart disease, so you should quit smoking and avoid secondhand smoke
Alcohol and caffeine can increase blood pressure and heart rate and trigger palpitations and arrhythmias.
Managing stress and anxiety, since they can affect heart function and blood pressure
Follow your doctor's instructions and take your medications as prescribed, as some drugs can affect valve function or cause side effects
Early diagnosis and treatment will improve the outcome if you report any new or worsening symptoms to your doctor
