Diagnosis
To diagnose mitral valve regurgitation, a health care provider will usually do a physical exam and ask questions about your symptoms and medical history, including whether you have mitral valve prolapse. The provider will typically listen to your heart with a stethoscope. A heart murmur, also called a holosystolic murmur, may be heard. The mitral valve heart murmur is the sound of blood leaking backward through the valve.
Tests may be done to confirm a diagnosis of mitral valve regurgitation or to check for other conditions that can cause similar signs and symptoms.
Tests
Echocardiogram
A health care provider performs an echocardiogram at Mayo Clinic.
Common tests to diagnose mitral valve regurgitation include:
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Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the structure of the mitral valve and blood flow in the heart. A standard echocardiogram, also called a transthoracic echocardiogram (TTE), can confirm a diagnosis of mitral valve regurgitation and determine its severity. Echocardiography can also help in the diagnosis of congenital mitral valve disease, rheumatic mitral valve disease and other heart valve conditions.
Sometimes, a transesophageal echocardiogram (TTE) 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). Wires (electrodes) attached to pads on the skin measure electrical signals from the heart. An ECG can detect irregular heart rhythms (arrhythmias) related to mitral valve disease.
- Chest X-ray. A chest X-ray shows the condition of the heart and lungs. This quick and easy test can help diagnose an enlarged heart or fluid in the lungs.
- Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of the heart. Cardiac MRI may help provide more details about the severity of mitral valve regurgitation and the size and function of the lower left heart chamber (left ventricle).
- 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 show how the heart responds to physical activity and whether mitral valve regurgitation symptoms occur during exercise. If you can't exercise, you might be given medication that mimics the effect of exercise on the heart.
- Cardiac catheterization. This test isn't often used to diagnose mitral valve disease, but it can be helpful if other tests haven't diagnosed the condition. 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 arteries in the heart chambers show up more clearly on an X-ray.
Staging
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.
Outlook
How well a person does after being diagnosed with mitral valve regurgitation varies. The outlook (prognosis) for mitral valve regurgitation depends on:
- The cause of the mitral valve disease
- The stage of heart valve disease
- The severity of the leakage (regurgitation)
- How long the condition has been present (duration)
About one in 10 people with chronic mitral valve regurgitation due to prolapse needs surgery to repair or replace the valve.
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Treatment
The goals of mitral valve regurgitation treatment are to improve heart function while reducing signs and symptoms and avoiding future complications. Some people, especially those with mild regurgitation, might not need treatment. Your health care provider will consider your symptoms and stage of regurgitation, among other things, when discussing treatment options with you.
Treatment of mitral valve regurgitation may include:
- Healthy lifestyle changes
- Regular monitoring by a health care provider
- Medications to treat symptoms and prevent complications, such as blood clots
- Surgery to repair or replace the mitral valve
A doctor trained in heart disease (cardiologist) typically provides care for people with mitral valve regurgitation. If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of health care providers trained and experienced in evaluating and treating heart valve disease.
Medications
Medications may be needed to reduce mitral valve regurgitation symptoms and to prevent complications of heart valve disease.
Types of medications that may be prescribed for mitral valve regurgitation include:
- Diuretics. Sometimes called water pills, this type of medication reduces or prevents fluid buildup in the lungs and other parts of the body.
- Blood thinners (anticoagulants). If you have atrial fibrillation due to mitral valve disease, such as mitral valve regurgitation, your health care provider may recommend blood-thinning drugs to prevent blood clots. Atrial fibrillation increases the risk of blood clots and strokes.
- Blood pressure medications. High blood pressure (hypertension) makes mitral valve regurgitation worse. If you have mitral valve regurgitation and hypertension, your health care provider may prescribe medication to lower blood pressure.
Surgery or other procedures
A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don't have symptoms. Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement. Your health care provider can discuss the risks and benefits of each type of heart valve with you to determine which valve may be best for you.
If you need surgery for another heart condition, a surgeon might perform mitral valve repair or replacement at the same time as that other surgery.
Mitral valve surgery is usually done through a cut (incision) in the chest. Surgeons at some medical centers sometimes use robot-assisted heart surgery, a minimally invasive procedure in which robotic arms are used to do the surgery.
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
Mitral valve repair
Mitral valve repair
In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).
Mitral valve repair
Mitral valve repair
In mitral valve repair, a surgeon removes the part of the mitral valve that doesn't close properly, as shown in the top image. Then the surgeon sutures together the edges and cinches the circumference of the valve with an annuloplasty band to support the valve, as shown in the bottom image.
Mitral valve repair saves the existing valve and may preserve heart function. Whenever possible, mitral valve repair is recommended before considering valve replacement. People who have mitral valve repair for mitral regurgitation at an experienced medical center generally have good outcomes.
During mitral valve repair surgery, the surgeon 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 doctor specializing in heart diseases (cardiologist) guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip is used to improve the closure of the mitral valve leaflets and to reduce the amount of regurgitation. 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
Repair of previously replaced valve
Repair of previously replaced valve
If a previously replaced mitral valve has a leak surrounding the artificial valve, a cardiologist may insert a device to stop the leak.
During mitral valve replacement, the 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).
Sometimes, a heart catheter procedure is done to place a replacement valve into a biological tissue valve that no longer works well. 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 life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.
Mayo Clinic Minute: Mitral valve clip
The blue purple splashing you see here is the problem, a backwards flow of blood from a leaky mitral valve. And the little white device can be a solution.
The mitral valve is named the mitral valve because it looks kind of like the pope's miter, that hat with two leaflets.
Mayo Clinic cardiologist, Dr. Peter Pollak, says this metal clip is a new option for fixing a leaflet that leaks or is torn.
What we can do with this technology is staple, or clip, those two leaflets together and reduce, or eliminate, the amount of leak that's going backwards.
Smaller than a dime, and implanted using a catheter tube, the clip is intended for patients who are too old or too sick for traditional surgery.
They just wouldn't recover from the open chest procedure.
But thanks to this closed chest beating heart procedure, now there's another way to mend a mitral valve leak.
It allows them to feel better almost immediately.
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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
Your health care provider may suggest that you make several heart-healthy lifestyle changes. Take these steps:
- Manage blood pressure. Control of high blood pressure is important if you have mitral valve regurgitation.
- Eat a heart-healthy diet. Food doesn't directly affect mitral valve regurgitation. But a healthy diet can help prevent other heart disease that can weaken the heart muscle. Eat foods that are low in saturated and trans fats, sugar, salt, and refined grains, such as white bread. Eat a variety of vegetables and fruits, whole grains, and proteins, such as lean meats, fish and nuts.
- Get regular exercise. How long and hard you're able to exercise can depend on whether you have mild, moderate or severe mitral valve regurgitation. Ask your health care provider for guidance before starting to exercise, especially if you're considering competitive sports.
- Maintain a healthy weight. You and your health care provider can discuss a healthy weight goal.
- Prevent infective endocarditis. If you've had mitral valve replacement, your health care provider will recommend that you take antibiotics before dental procedures to prevent an infection called infective endocarditis.
- Avoid or limit alcohol. Heavy alcohol use can cause arrhythmias and can make your symptoms worse. Excessive alcohol use can also cause cardiomyopathy, a condition of weakened heart muscle that leads to mitral regurgitation. Ask your health care provider about the effects of drinking alcohol.
- Avoid tobacco. If you smoke, quit. Ask your health care provider about resources to help you quit smoking. Joining a support group may be helpful.
- Get regular health checkups. Establish a regular schedule with your cardiologist or primary care provider. Tell your health care provider if you have any changes in your signs or symptoms.
Women with mitral valve regurgitation should talk to their health care provider before trying to get pregnant. Pregnancy causes the heart to work harder. How a heart with mitral valve regurgitation tolerates this extra work depends on the degree of regurgitation and how well the heart pumps.
Preparing for your appointment
If you think you have mitral valve regurgitation, 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 regurgitation.
- Write down key personal information, including a family history of heart disease, heart defects, genetic disorders, stroke, high blood pressure or diabetes, 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, to 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 to your health care provider about challenges you might face in getting started.
- Write down questions to ask your health care provider.
For mitral valve regurgitation, some basic questions to ask your health care provider include:
- What is likely causing my condition?
- What are other possible causes for my symptoms?
- 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?
- If I need surgery, which surgeon do you recommend for mitral valve repair?
- 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 a number of questions, including:
- When did your symptoms begin?
- Are your symptoms constant or do they come and go?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Feb. 08, 2022