Mitral Valve Regurgitation

A condition in which your heart’s mitral valve does not close tightly, allowing blood to flow backward in your heart is called mitral valve regurgitation (mitral regurgitation, mitral insufficiency, and mitral incompetence). You may feel tired or out of breath because blood cannot move through your heart and to the rest of your body.

The treatment varies on how severe your condition while for mild leakage treatment might not be necessary. For severe leakage you may need heat surgery to replace or repair the valve.

If this disease is not treated, it can cause arrhythmias and heart failure.

Symptoms of mitral valve regurgitation include:

• shortness of breath (dyspnea),
• fatigue,
• blood flowing turbulently in your heart (heart murmur),
• swollen feet or ankles,
• heart palpitations.

You may not have symptoms for decades and be unaware that you have this condition because this is often mild and progress slowly. Heart murmur is the first sign that your doctor will suspect that you have mitral valve regurgitation.

Causes of mitral valve regurgitation vary depending on its type.

Mitral valve regurgitation can be classified as primary (caused by an abnormality in the mitral valve) and secondary (caused by an abnormality in the left ventricle of the heart). The possible causes of mitral valve regurgitation are:

Damaged tissue cords – it may stretch or tear and can cause leakage through the mitral valve and may require heart surgery;

Mitral valve prolapse – it can stretch and weaken the tendon like cords supporting the mitral valve;

Endocarditis – an infection of the lining of the heart (endocarditis) is the cause of this;

Rheumatic fever – a complication of strep throat that can lead to mitral valve regurgitation;

Abnormality of the heart muscle (cardiomyopathy) – can stretch the tissue around your mitral valve leading to leakage;

Heart attack – can cause severe mitral valve regurgitation by damaging the area of the heart muscle;

Congenital heart defects – some babies are born with this;

Trauma – like accidents can lead to mitral valve regurgitation;

Radiation therapy – radiation therapy focused on the chest;

Certain drugs – containing ergotamine (Cafergot, Migergot).

Making a diagnosis of mitral valve regurgitation is done by performing several tests.

Your physician may refer you to a cardiologist. He will ask about your medical history and family history of heart disease. He will also conduct a physical exam.

This disease usually produces heart murmur, so he will listen to your heart using a stethoscope.

Some of the test include:

• Echocardiogram – most commonly used to produce video images of your heart in motion and this assesses the structure of your heart, blood flow and mitral valve. Doctors may also use 3-D or transesophageal echocardiogram;
• Electrocardiogram – to measure electrical impulses from your heart, it can also detect abnormal heart rhythms and heart disease;
• Chest X-ray – to determine whether the left ventricle or left atrium is enlarged and to see the conditions of your lungs;
• Cardiac MRI – to determine the severity of your condition and to see the function of your lower left heart chamber (left ventricle);
• Cardiac catheterization – it provides detailed pictures of your heart arteries and heart functions and the pressure inside your heart chambers;
• Exercise tests – to monitor your heart’s reaction towards certain exercises;
• CT angiogram – can be performed in the abdomen, pelvis and chest to see if you can have a robotic mitral valve repair.

The treatment of mitral valve regurgitation depends on the severity of your condition. The treatment focuses on minimizing your signs and symptoms and improving your heart’s function. Some people might not need treatment but you will be monitored by your doctor along with regular evaluations. A mitral valve deformity cannot be corrected by medication but medicines such as anticoagulants or blood thinners can help prevent blood clots and diuretics can help relieve fluid accumulation in your legs and lungs, your doctor might even recommend low salt diet for controlling your blood pressure and not to have fluid buildups.

Even if your mitral valve is not causing symptoms, you may need surgical repair. New guidelines for mitral valve surgery that recommends earlier surgery for other people with primary mitral valve regurgitation was issued by the American College of Cardiology and the American Heart Association. This surgery should be done with a team of cardiac surgeons and cardiologists along with imaging specialists.

Your surgery options include:

• Valve repair – some people with mitral valve regurgitation prefers repair than replacement and this procedure preserves your own valve. Doctors will remove excess valve tissue so the leaflets can be close or by reconnecting valve leaflets, this is done by reinforcing or tightening the annulus which is called annuloplasty;
• Valve replacement – this can be a biological or mechanical valve. By removing the valve and replacing it with biological tissue (bioprosthetic) or mechanical, your doctor replaces the valve. In biological tissue valve it can come from cow, human deceased donor or pig while in mechanical it is made out of metal that can be durable and you might need anticoagulants medications for life to prevent blood clots such as warfarin (Coumadin, Jantoven); 
• There are also less invasive surgical procedures, minimally invasive surgeries are to be performed by a team of surgeons and this includes:
• Robot-assisted heart surgery – they will use robotic arms to conduct the mitral valve repair. Your heart will be viewed in a magnified high-definition 3-D view and his hand movements will be translated by the robotic arms but will be assisted by surgical team to change the surgical instruments that are attached by the robotic arms;
• Thoracoscopic surgery – a long, thin tube called thoracoscope that has a tiny high definition video camera will be inserted in a small cut in your chest and they will use long instruments to conduct the surgery;
• Ministernotomy – a small opening will be done in your breastbone to do the surgery. Minimally invasive heart surgeries will have fewer complications and you will feel less pain.
• In catheter procedure – to replace or repair the mitral valve, surgeons will use long thin tuber called catheters. They will repair a leaking bioprosthetic or mechanical valve that has been implanted by using catheter to plug the leak; they will even replace the valve if the bioprosthetic replacement valve is not working anymore and this can be done by inserting a catheter with a balloon at the end into a blood vessel in your leg and thread it to your heart. Then a replacement valve will be inserted inside the catheter using imaging and they will inflate the balloon and place the replacement valve inside the bioprosthetic valve to be expanded.

You cannot prevent mitral valve regurgitation but you can lower the chances of it by taking your medications and by visiting your doctor for follow ups.

Here are some tips to help you cope with mitral valve regurgitation:

• take medicines as prescribed by your doctor,
• stay physically active,
• find a support group in your area to help you cope with your condition.

There are several risks and complications associated with mitral valve regurgitation.

The risk factors of mitral valve regurgitation are:

• heart attack that can damage your heart,
• heart disease such as coronary heart disease,
• a history of mitral valve prolapse or stenosis,
• congenital heart disease which means you can be prone to regurgitation,
• infections such as endocarditis or rheumatic fever that causes inflammation can damage the mitral valve, 
• age usually middle age people,
• use of certain drugs containing ergotamine and cabergoline, and pergolide, fenfluramine and dexfenfluramine that are no longer sold.

Some complications may include:

• Heart failure – when there is fluid accumulation in your lungs and when there is less blood going forward with each beat, this can stain your heart,
• Pulmonary hypertension – a type of high blood pressure that affects the vessels in your lungs,
• Atrial fibrillation – can cause blood clots that can travel o other parts of your body and can cause problem such as stroke.