Diagnosis

To diagnose mitral valve disease, including mitral valve stenosis and mitral valve regurgitation, a health care provider will usually perform a physical exam and ask questions about your medical history.

The health care provider will listen for a heart murmur, a sign of a mitral valve condition.

Tests to diagnose mitral valve disease may include:

  • Echocardiogram. Sound waves are used to produce video images of the heart in motion. An echocardiogram provides a closer look at the mitral valve and how well it's working. An echocardiogram can help in the diagnosis of congenital mitral valve disease, rheumatic mitral valve disease and other heart valve conditions.

    Sometimes, a transesophageal echocardiogram may be done to get a closer look at the mitral valve. In this type of echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from the mouth to the stomach (esophagus).

  • Electrocardiogram (ECG or EKG). Wires (electrodes) attached to pads on the skin measure electrical signals from the heart. An ECG can detect enlarged chambers of the heart, heart disease and irregular heart rhythms.
  • Chest X-ray. A chest X-ray can show the condition of the heart and lungs. It can reveal whether the heart is enlarged, which can be a sign of certain types of heart valve disease.
  • Cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart. A cardiac MRI might be done to determine the severity of mitral valve disease.
  • Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests help reveal how the heart responds to physical activity and whether valve disease symptoms occur during exercise. If you're unable to exercise, you might be given medications that mimic the effect of exercise on your heart.
  • Cardiac catheterization. A health care provider threads a thin tube (catheter) through a blood vessel in the arm or groin to an artery in the heart and injects dye through the catheter. This makes the heart arteries show up more clearly on an X-ray.

    Cardiac catheterization isn't often used to diagnose mitral valve disease, but it can be used if other tests haven't diagnosed the condition or to check to see if coronary artery disease is present.

After testing confirms a diagnosis of mitral or other heart valve disease, your health care provider may tell you the stage of disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.

Heart valve disease is staged into four basic groups:

  • Stage A: At risk. Risk factors for heart valve disease are present.
  • Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
  • Stage C: Asymptomatic severe. There are no heart valve symptoms, but the valve disease is severe.
  • Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.

Treatment

Mitral valve disease treatment depends on the symptoms, the severity of the condition, and whether the condition is worsening.

A doctor trained in heart disease (cardiologist) typically provides care for people with mitral valve disease. Treatment of mitral valve disease might include monitoring the condition with regular follow-up visits. If you have mitral valve disease, you might be asked to:

  • Make healthy lifestyle changes
  • Take medications to treat symptoms
  • Take blood thinners to reduce the risk of blood clots if you have a certain irregular heart rhythm called atrial fibrillation

Surgery or other procedures

A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if no symptoms are present. Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement.

If you need surgery for another heart condition, a surgeon might perform mitral valve repair or replacement at the same time.

Surgeons at some medical centers perform robot-assisted heart surgery, a type of minimally invasive heart surgery in which robotic arms are used to conduct the procedure.

Robot-assisted minimally invasive mitral valve repair at Mayo Clinic

In robot-assisted mitral valve repair surgery at Mayo Clinic, two board-certified cardiac surgeons use robotic equipment to perform the exact same procedure conducted in traditional open chest heart surgery, without needing to make a large incision through your breast bone. Your surgeons perform the procedure through small incisions in your right chest, using finger-sized instruments that are slipped in between your ribs. In this procedure, one surgeon sits at a remote console and views your heart using a magnified high-definition 3D view on a video monitor. Another surgeon works at the operating table and ensures the safe movement of the robotic arms. You'll need to be supported by a heart-lung bypass machine during the procedure. This will allow your surgeons to stop your heart briefly and insert instruments into the inner chambers to repair the mitral valve. Your surgeon uses robotic arms to duplicate specific maneuvers used in open-chest surgeries. The procedure is performed through small openings in your chest, through which will be inserted micro instruments and a thin high-definition camera tube or thoracoscope. One opening will be a mini working port through which surgeons will insert materials used during the procedure. Your surgeon performs the procedure from the remote console. Your surgeon's hand movements are translated precisely to the robotic arms at the operating table, which move like a human wrist. At the operating table, another surgeon works together with the surgeon at the console to perform the procedure and ensure it is conducted safely and efficiently. Your surgeon at the console can closely examine the complicated mitral valve problem using the high-definition 3D video monitor. This allows your surgeon to have a clearer, more lifelike perspective of your heart than is possible during open heart surgery, in which surgeons view the heart from a further distance.

To repair the mitral valve, your surgeon makes an incision in the left upper chamber or left atrium of your heart to access the mitral valve. Your surgeon can then identify the problem with your mitral valve and repair the valve itself. In mitral valve prolapse, the mitral valve, located between your heart's left atrium and the left lower chamber or left ventricle, doesn't close properly. The leaflets of the valve bulge or prolapse upward or back into the left atrium as your heart contracts. This leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation. To repair this condition, various complicated technical procedures are performed. Sometimes a small section of the leaflet, the part of the valve that doesn't close properly, is identified, and a triangular section is removed, as shown.  Your surgeon then stitches the cut edges of the leaflet together to repair the valve.

In other cases, new chords or chordae supporting the broken leaflet are inserted. An annuloplasty band is then placed around the circumference of the valve to stabilize the repair. Your surgeon will close the incisions in your chest after the procedure. Mayo's staff will assist you during your recovery over a three-day period in the hospital. In robot-assisted heart surgery, most people have a quicker recovery, smaller incisions, and less pain than following open-chest surgery. Studies have also found that this procedure performed at Mayo Clinic is cost effective, with similar or lower total costs compared with traditional open-chest surgery.

Mitral valve repair

During mitral valve repair surgery, the doctor might:

  • Patch holes in a heart valve
  • Reconnect the valve flaps
  • Remove excess tissue from the valve so that the flaps can close tightly
  • Repair the structure of the mitral valve by replacing cords that support it
  • Separate valve leaflets that have fused

Other mitral valve repair procedures include:

  • Annuloplasty. A surgeon tightens or reinforces the ring around the valve (annulus). Annuloplasty may be done with other techniques to repair a heart valve.
  • Valvuloplasty. This catheter procedure is used to repair a mitral valve with a narrowed opening. Valvuloplasty might be done even if you don't have symptoms. The surgeon inserts a catheter with a balloon on the tip into an artery in the arm or groin and guides the catheter to the mitral valve. The balloon is inflated, widening the mitral valve opening. The balloon is deflated, and the catheter and balloon are removed.
  • Mitral valve clip. In this procedure, a surgeon guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip is used to fix a torn or leaky mitral valve leaflet. This procedure is an option for people who have severe mitral valve regurgitation or who aren't a good candidate for mitral valve surgery.

Mitral valve replacement

During mitral valve replacement, the heart surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

In some cases, a heart catheter procedure may be done to insert a replacement valve into a biological tissue valve that is no longer working properly. This is called a valve-in-valve procedure.

If you had mitral valve replacement with a mechanical valve, you'll need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

You'll have regular follow-up appointments with your health care provider to monitor your condition.

It's also important to make heart-healthy lifestyle changes, including:

  • Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
  • Maintaining a healthy weight. If you are overweight or have obesity, your health care provider might recommend that you lose weight.
  • Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
  • Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
  • Avoiding tobacco. If you smoke, quit. Ask your health care provider about resources to help you quit smoking. Joining a support group may be helpful.

If you have mitral valve disease and want to become pregnant, it's important to talk with a health care provider first. A health care provider can discuss which medications are safe to take during pregnancy, and whether a procedure is needed to treat a heart valve condition before pregnancy. Women with heart valve disease usually require close monitoring by a health care provider during pregnancy.

Coping and support

If you have mitral valve disease, here are some steps that may help you manage your condition:

  • Take medications as prescribed. Take your medications as directed by your health care provider.
  • Get support. Having support from your family and friends can help you cope with your condition. Ask your health care provider about support groups that may be helpful.
  • Stay active. It's a good idea to stay physically active. Your health care provider may give you recommendations about how much and what type of exercise is appropriate for you.

Preparing for your appointment

If you think you have mitral valve disease, make an appointment to see your health care provider. Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
  • Write down your symptoms, including any that seem unrelated to mitral valve disease.
  • Write down key personal information, including a family history of heart disease, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you take.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
  • Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk about challenges you might face in getting started.
  • Write down questions to ask your health care provider.

For mitral valve disease, some basic questions to ask your health care provider include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests will I need?
  • What's the best treatment?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • If I need surgery, which surgeon do you recommend for heart valve surgery?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your health care provider is likely to ask you several questions, including:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Mitral valve disease care at Mayo Clinic

Nov. 11, 2021
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