Your doctor will ask about your medical history and your family history of heart disease. Your doctor will also perform a physical exam that includes listening to your heart with a stethoscope. Mitral valve regurgitation usually produces a sound of blood leaking backward through the mitral valve (heart murmur).
Your doctor will then decide which tests are needed to make a diagnosis. For testing, you may be referred to a cardiologist.
Common tests to diagnose mitral valve regurgitation include:
Echocardiogram. This test is commonly used to diagnose mitral valve regurgitation. In this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest produce video images of your heart in motion.
This test assesses the structure of your heart, the mitral valve and the blood flow through your heart. An echocardiogram helps your doctor get a close look at the mitral valve and how well it's working. Doctors also may use a 3-D echocardiogram.
Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram. In this test, a small transducer attached to the end of a tube is inserted down your esophagus, which allows a closer look at the mitral valve than a regular echocardiogram does.
- Electrocardiogram (ECG). Wires (electrodes) attached to adhesive pads on your skin measure electrical impulses from your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
- Chest X-ray. This enables your doctor to determine whether the left atrium or the left ventricle is enlarged — possible indicators of mitral valve regurgitation — and the condition of your lungs.
- Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and assess the size and function of your lower left heart chamber (left ventricle).
- Cardiac CT. A CT angiogram may be performed of the chest, abdomen and pelvis to determine whether you're a candidate for robotic mitral valve repair.
- Exercise tests or stress tests. Different exercise tests help measure your activity tolerance and monitor your heart's response to physical exertion. If you are unable to exercise, medications to mimic the effect of exercise on your heart may be used.
- Cardiac catheterization. This test isn't often used to diagnose mitral valve regurgitation. This invasive technique involves threading a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart and injecting dye through the catheter to make the artery visible on an X-ray. This provides a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.
Mitral valve regurgitation treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse. The goal of treatment is to improve your heart's function while minimizing your signs and symptoms and avoiding future complications.
A doctor trained in heart disease (cardiologist) will provide your care. If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.
Some people, especially those with mild regurgitation, might not need treatment. However, the condition may require monitoring by your doctor. You may need regular evaluations, with the frequency depending on the severity of your condition. Your doctor may also recommend making healthy lifestyle changes.
Your doctor may prescribe medication to treat symptoms, although medication can't treat mitral valve regurgitation.
Medications may include:
- Diuretics. These medications can relieve fluid accumulation in your lungs or legs, which can accompany mitral valve regurgitation.
- Blood thinners. These medications can help prevent blood clots and may be used if you have atrial fibrillation.
- High blood pressure medications. High blood pressure makes mitral valve regurgitation worse, so if you have high blood pressure, your doctor may prescribe medication to help lower it.
Your mitral valve may need to be repaired or replaced. Doctors may suggest mitral valve repair or replacement even if you aren't experiencing symptoms, as this may prevent complications and improve outcomes. If you need surgery for another heart condition, your doctor may repair or replace the diseased mitral valve at the same time.
Mitral valve surgery is usually performed through a cut (incision) in the chest. In some cases, doctors may conduct minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.
Doctors at some medical centers may perform robot-assisted heart surgery, a type of minimally invasive heart surgery. In this type of surgery, surgeons view the heart in a magnified high-definition 3-D view on a video monitor and use robotic arms to duplicate specific maneuvers used in open-heart surgeries.
Your doctor will discuss with you whether mitral valve repair or mitral valve replacement may be most appropriate for your condition. He or she may also evaluate you to determine whether you're a candidate for minimally invasive heart surgery or open-heart surgery.
Doctors often may recommend mitral valve repair, as it preserves your own valve and may preserve heart function. However, if mitral valve repair isn't possible, doctors may need to perform mitral valve replacement.
Surgery options include:
Mitral valve repair
Surgeons can repair the valve by reconnecting valve flaps (leaflets), replacing the cords that support the valve, or removing excess valve tissue so that the leaflets can close tightly. Surgeons may often tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).
Doctors may use long, thin tubes (catheters) to repair the mitral valve in some cases. In one catheter procedure, doctors insert a catheter with a clip attached in an artery in the groin and guide it to the mitral valve. Doctors use the clip to reshape the valve. People who have severe symptoms of mitral valve regurgitation and who aren't candidates for surgery or who have high surgical risk may be considered for this procedure.
In another procedure, doctors may repair a previously replaced mitral valve that is leaking by inserting a device to plug the leak.
Mitral valve replacement
If your mitral valve can't be repaired, you may need mitral valve replacement. In mitral valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Biological tissue valves degenerate over time, and often eventually need to be replaced. People with mechanical valves need to take blood-thinning medications for life to prevent blood clots.
Your doctor can discuss the risks and benefits of each type of heart valve with you and discuss which valve may be appropriate for you.
Doctors continue to study catheter procedures to repair or replace mitral valves. Some medical centers may offer mitral valve replacement during a catheter procedure as part of a clinical trial for people with severe mitral valve disease who are aren't candidates for surgery. A catheter procedure can also be used to insert a replacement valve in a biological tissue replacement valve that is no longer working properly.
Talk to your doctor about what type of follow-up you need after surgery, and let your doctor know if you develop new symptoms or if your symptoms worsen after treatment.
Lifestyle and home remedies
Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including:
- Keeping your blood pressure under control. Control of high blood pressure is important if you have mitral valve regurgitation.
- Eating 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.
- Maintaining a healthy weight. Keep your weight within a range recommended by your doctor.
- Preventing infective endocarditis. If you have had a heart valve replaced, your doctor may recommend you take antibiotics before dental procedures to prevent an infection called infective endocarditis. Check with your doctor to find out if he or she recommends that you take antibiotics before dental procedures.
- Cutting back on 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 doctor about the effects of drinking alcohol.
- Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.
- Getting regular physical activity. How long and hard you're able to exercise depends on the severity of your condition and the intensity of exercise. Ask your doctor for guidance before starting to exercise, especially if you're considering competitive sports.
- Seeing your doctor regularly. Establish a regular evaluation schedule with your cardiologist or primary care provider. Tell your doctor if you have any changes in your signs or symptoms.
If you're a woman with mitral valve regurgitation, it's important to talk to your doctor before you become 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 your heart pumps. Throughout your pregnancy and after delivery, your cardiologist and obstetrician should monitor you.
Coping and support
If you have mitral valve regurgitation, here are some steps that may help you cope:
- Take medications as prescribed. Take your medications as directed by your doctor.
- Get support. Having support from your family and friends can help you cope with your condition. Ask your doctor about support groups that may be helpful.
- Stay active. It's a good idea to stay physically active. Your doctor 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 regurgitation, make an appointment to see your doctor. 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. 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 to your doctor about challenges you might face in getting started.
- Write down questions to ask your doctor.
For mitral valve regurgitation, some basic questions to ask your doctor 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 mitral valve repair?
- 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 doctor is likely to ask you a number of 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?