Mitral Valve Disease

Mitral Valve Regurgitation

Mitral valve regurgitation, or mitral regurgitation, occurs when the mitral valve doesn't close tightly and blood flows backward in the heart. Mitral regurgitation from mitral valve prolapse is the most common reason for surgical treatment.

If not treated, mitral valve regurgitation can lead to congestive heart failure. Treatment depends on the severity of regurgitation, how far mitral valve disease has progressed, and signs and symptoms of the disease.

A team of heart valve disease specialists at Mayo Clinic coordinates the patient's care to provide a complete examination, diagnosis and extensive patient education in just a few days. Patients range from those who want to have a heart murmur checked, to those who have been told they have advanced mitral heart valve disease.

If surgery is indicated, a cardiac surgeon meets with the patient to thoroughly discuss surgical options. In most cases, surgery can be performed the next day — depending on the patient's preference. Mayo Clinic is a major medical center and conducts clinical trials and research on various aspects of heart valve disease. Some Mayo patients may be eligible to participate in research that tests new treatment approaches.

Symptoms

Signs and symptoms of mitral regurgitation depend on how severely and quickly the condition develops. Most often, mitral regurgitation is mild, and severe mitral regurgitation develops slowly. If no symptoms develop for decades, the patient may not know the condition is present.

Signs and symptoms can develop gradually because, for some time, the heart can compensate for the defect. The first notable sign is usually an abnormal sound, or heart murmur. Sometimes, however, the disorder develops quickly, and the patient may experience the abrupt onset of more severe signs and symptoms.

Indicators of mitral regurgitation include:

• Shortness of breath, especially with physical exertion or when the person lies down
• Fatigue, especially during increased activity
• Cough, especially at night or when lying down
• Awakening at night with shortness of breath
• Heart palpitations — sensations of a rapid, fluttering heartbeat
• Swollen feet or ankles

Causes

Any condition that damages the mitral valve can cause regurgitation, including:

Mitral valve prolapse

Mitral regurgitation from mitral valve prolapse is the most common reason for surgical treatment. Mitral valve prolapse occurs when the leaflets and supporting cords of the mitral valve have excess tissue, and they weaken. With each contraction of the left ventricle, the valve leaflets bulge (prolapse) into the left atrium. This common heart defect may prevent the mitral valve from closing tightly and lead to regurgitation. Mitral valve prolapse is common. Many who have it never develop severe regurgitation.

Damaged cords

Mitral regurgitation may result from damage to the cords that anchor the flaps of the mitral valve to the heart wall. Over time, these cords may stretch or suddenly tear, especially in people who have mitral valve prolapse. A sudden tear can cause substantial leakage through the mitral valve.

Repair may involve emergency heart surgery.

Deterioration of the valve with age

The mitral valve opens and shuts tens of thousands of times a day. Age-related wear and tear on the valve can lead to mitral regurgitation. Mayo Clinic has extensive experience in successfully treating elderly patients who have mitral regurgitation.

Prior heart attack

A heart attack can damage the area of the heart muscle that supports the mitral valve, affecting the function of the valve. If the damage is extensive enough, a heart attack may result in sudden and severe mitral regurgitation.

Endocarditis

The mitral valve can be damaged by endocarditis — an infection inside the heart that can involve the heart valves. Read more about endocarditis prevention.

Congenital heart defect

Some infants are born with defects in their heart, including a leaking mitral valve.

Rheumatic fever

This now-rare (in the United States) complication of strep throat was once a common childhood illness. It can damage the mitral valve, leading to mitral stenosis later in life. In some people, the body's response to the strep throat infection leads to mitral valve damage, causing the mitral valve to become inflamed, thicken, and leak (mitral regurgitation). This inflammatory process can cause the valve to fuse and harden, resulting in mitral stenosis. People who have had rheumatic fever may have both mitral stenosis and mitral regurgitation. Many older adults in the United States were exposed to rheumatic fever as children. In developing countries, rheumatic fever is the leading cause of mitral valve disease.