Mitral Regurgitation

Mitral regurgitation is an abnormal heart condition and is the most common form of heart valve disease or valvular heart disease.

The mitral valve is one of the four valves of the heart. It is situated between the two left chambers (left atrium and left ventricle) of the heart. It controls the flow of blood between the heart's lower and upper chambers on the left side. In a healthy heart, the valve's two flaps (also called leaflets or cusps) close and open like a double door and form a tight seal every time they close, which keeps the blood flowing in the proper direction. With mitral valve regurgitation, the leaflets do not seal properly, which causes the blood to leak backward into the heart. This forces the heart to work harder to pump blood out to the body, causing fatigue and shortness of breath. If the backflow or regurgitation is severe enough, the heart may expand over time as a way to maintain blood flow, and this can lead to high blood pressure in the lungs (pulmonary hypertension) and heart failure.

Mitral regurgitation is also called mitral valve regurgitation, mitral insufficiency, and mitral incompetence.

Causes

Mitral regurgitation may occur due to several reasons, such as:

• Congenital heart abnormalities or structural heart problems noted at birth
• Mitral valve prolapse, a common heart deformity in which the mitral valve flaps bulge backwards into the left atrium during the heart's contraction
• Endocarditis, an infection that affects the lining of the heart
• Cardiomyopathy, a weakened heart muscle as a result of a heart attack,  hypertension, inherited disease, or viruses
• Deterioration of the valve flaps that occurs with aging
• Rheumatic fever, which can occur as a result of strep throat
• Radiation therapy focused on the chest region

Signs and Symptoms

Mitral regurgitation often develops slowly without any apparent symptoms. As the condition progresses, you may notice valvular heart disease symptoms, such as:

• Dyspnea (shortness of breath), especially when lying down or upon exertion
• Heart palpitations - a sensation of a fluttering, fast-beating, or pounding heart
• Unusual fatigue or tiredness
• Swelling of the ankles or feet
• Pain or pressure in the chest
• Decreased ability to exercise
• Swollen abdomen or distended neck veins

Diagnosis

In order to diagnose mitral regurgitation, your doctor will start by reviewing your symptoms, medical history, and any family history of heart disease. You will undergo a thorough physical exam that includes listening to your heartbeat using a stethoscope to detect abnormalities such as a rapid heartbeat or flutter. Your doctor may also order other diagnostic tests such as a cardiac MRI, echocardiogram, electrocardiogram (ECG), and computed tomography (CT) scans for further analysis, and to confirm mitral regurgitation.

Treatment

Treatment for mitral regurgitation depends upon the severity and cause of the condition, and other factors such as age and overall health of the patient.

In general, the different approaches involved in the treatment of mitral regurgitation include:

Lifestyle Modifications

Your doctor may suggest the following lifestyle changes if there are no evident symptoms of mitral regurgitation:

• Consume a healthy diet low in trans and saturated fats, salt and sugar. Avoid refined grains like white bread. Include fruits, vegetables, nuts, and whole grains.
• Keep your blood pressure under control.
• Maintain a healthy weight.
• Reduce alcohol intake and refrain from smoking.
• Perform regular physical activities.
• Visit your doctor regularly.

Medications

Your doctor may prescribe medications if you have symptoms of mitral regurgitation. These may include:

• Blood pressure medications to control your high blood pressure
• Blood thinners to prevent blood clots and provide symptomatic relief from atrial fibrillation
• Diuretics to reduce fluid accumulation in your legs or lungs

Surgery

Your doctor may recommend surgery if medications do not improve your symptoms or condition. Mitral regurgitation can be treated either through a repair or replacement of the mitral valve.

Mitral valve surgery can be performed through any of these approaches:

• Open-heart surgery that involves making a relatively large incision in your chest
• Percutaneous procedure (through a vein) to place a clip on the valve.
• Minimally invasive heart surgery that involves making one or two smaller incisions in your chest using specialized instruments
• Robot-assisted heart surgery, a type of minimally invasive surgery where your surgeon views a magnified, high-definition, 3-D view of your heart on a monitor and uses precision-guided robotic arms.

Summary

The mitral valve is a small flap in the heart that prevents blood flowing in the wrong direction. Problems with this valve can impact how blood flows around the heart and to the body.  In most cases, the symptoms of mitral regurgitation can be treated with medications or minimally invasive surgical approaches.