Treatments and drugs

By Mayo Clinic Staff

Mitral valve regurgitation treatment depends on how severe your condition is, and if it's getting worse. The goal of treatment is to improve your heart's function while minimizing your signs and symptoms and avoiding future complications.

Observation

Some people, especially those with mild regurgitation, don't need to be treated. However, even if you don't have signs and symptoms with mitral valve regurgitation, the condition may require monitoring by your doctor. You may need regular evaluations, with the frequency depending on the amount of regurgitation.

Observation isn't the same as ignoring the condition. Working with your doctor, you should keep a close eye on your symptoms in case you do end up needing treatment.

Medications

Medication can't correct a deformity of a mitral valve. But medications such as diuretics are available to relieve fluid accumulation in your lungs or legs, which can accompany mitral valve regurgitation. High blood pressure makes mitral valve regurgitation worse, so if you have high blood pressure, your doctor may prescribe medication to help lower it. Following a low-salt diet helps prevent fluid buildup and helps control blood pressure.

Surgery

Your mitral valve may need to be surgically repaired or replaced. If you feel good, you may question the need for open-heart surgery. But you can have bad mitral valve regurgitation and yet feel good. This is because the heart is good at counteracting problems caused by a leaky mitral valve.

However, if you wait too long to have surgery, your heart might become damaged beyond repair or become so weakened that surgery wouldn't help. That's why it's important to closely monitor mitral valve regurgitation and get surgery if your doctor feels it will help you avoid future problems.

Discuss the risks and benefits of surgery with your doctor. Your surgery options include:

  • Valve repair. Mitral valve repair is a surgery that preserves your own valve. For most people with mitral valve prolapse, this is the preferred surgical treatment to correct your condition.

    Your mitral valve consists of two triangular-shaped flaps of tissue called leaflets. The leaflets of the mitral valve connect to the heart muscle through a ring called the annulus. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annulus). This is called an annuloplasty. It's important to have an experienced surgeon perform mitral valve repair.

  • Valve replacement. Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. The two types of artificial valves are mechanical and tissue.

    Mechanical valves, which are made of metal, may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke.

    Tissue valves are made from animal tissue such as a pig's heart valve. These kinds of valves are called bioprostheses. They may wear out over time and need replacement. However, an advantage of the tissue valve is that you don't have to use long-term anticoagulant medication.

Mitral valve repair or replacement requires open-heart surgery under general anesthesia. With traditional open-heart surgery, a cut that's the length of your breastbone (sternum) is made and your heart is exposed and connected to a heart-lung machine that assumes your breathing and blood circulation functions during the procedure. Your surgeon then replaces or repairs the valve. After the operation, you'll spend one or more days in an intensive care unit, where your heart function and general recovery will be closely monitored.

Mitral valve regurgitation can be eliminated with surgery, but some people may continue to have some leakage. How well you do depends on whether the valve was repaired or replaced, how much regurgitation is left, and your heart's pumping function. Talk to your doctor about what type of follow-up you need after surgery, and let your doctor know if you develop new or worsening signs and symptoms after treatment.

Less invasive techniques

Doctors are developing less invasive techniques to treat valve disorders, such as repairing or replacing mitral valves using heart catheterization or robotic techniques.

Some surgeons now repair the mitral valve through smaller cuts in your chest (minimally invasive cardiac surgery). People who have minimally invasive cardiac surgery usually have a shorter recovery time and leave the hospital sooner. These techniques are not for everyone, so talk to your surgeon to see if this type of surgery might be right for you.

Sep. 15, 2011