Mitral valve regurgitation
Mitral valve regurgitation
Mitral valve regurgitation — or mitral regurgitation — happens when your heart's mitral valve doesn't close tightly, which allows blood to flow backward in your heart. When the mitral valve doesn't work properly, blood can't move through your heart or to the rest of your body as efficiently, making you feel tired or out of breath. Mitral valve regurgitation is also called mitral insufficiency or mitral incompetence.
Treatment of mitral valve regurgitation depends on how severe your condition is, whether it's getting worse, and signs and symptoms. For mild cases, treatment may not be necessary. You may need heart surgery to repair or replace the valve for more-severe cases. Left untreated, severe mitral valve regurgitation can cause heart failure or serious heart rhythm problems (arrhythmias).
Signs and symptoms of mitral valve regurgitation depend on its severity and how quickly the condition develops. Mitral valve regurgitation signs and symptoms can include:
Mitral valve regurgitation is often mild and progresses slowly. You may have no symptoms for decades and be unaware that you have this condition.
Mitral valve regurgitation is often first suspected when your doctor hears a heart murmur. Sometimes, however, the problem develops quickly, and you may experience a sudden onset of severe signs and symptoms.
When to see a doctor
However, mitral valve regurgitation is usually discovered earlier, during a routine examination when your doctor listens to your heart with a stethoscope. Mitral valve regurgitation can cause an abnormal heart sound (heart murmur).
When mild, mitral valve regurgitation may not progress and may never pose a serious threat to your health. But when severe, mitral valve regurgitation may cause heart complications and may require surgery to correct.
Your heart, which is the pump of your circulatory system, has four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.
Blood flows through your heart's chambers, aided by four heart valves. These valves open and close, allowing blood to flow through your heart in only one direction. The mitral valve — which lies between the two left chambers of your heart — has two triangular-shaped flaps of tissue called leaflets.
Heart valves open like a trapdoor. The leaflets of the mitral valve open when the left atrium contracts, forcing blood through the leaflets and into the left ventricle. When the left atrium relaxes between heart contractions, the flaps shut to prevent blood that has just passed into the left ventricle from flowing backward, in the wrong direction.
When working properly, heart valves open and close fully. In mitral valve regurgitation, the mitral valve doesn't close tightly. So, with each heartbeat, some blood from the left ventricle flows backward into the left atrium, instead of forward into the aorta. Regurgitation refers to this backflow of blood through the heart valve.
Causes of mitral valve regurgitation
Severe mitral valve regurgitation — regardless of its cause — can weaken your heart. When the left ventricle contracts in a heart with mitral valve regurgitation, some blood flows backward into the left atrium instead of flowing forward into the aorta. As a result, blood flow to the rest of your body decreases. In response, the left ventricle may enlarge (dilate) so that it can pump more blood with each heartbeat. At first this adaptation helps your heart beat with more force. But eventually, the change weakens your heart and may cause heart failure and heart rhythm irregularities, such as atrial fibrillation.
Chambers and the valves of the heart
A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood ...
Several factors can increase your risk of mitral valve regurgitation, including:
When it's mild, mitral valve regurgitation may never cause problems. But when it's severe, mitral valve regurgitation may lead to these complications:
Preparing for your appointment
If you think you have mitral valve regurgitation, make an appointment to see your doctor. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For mitral valve regurgitation, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Tests and diagnosis
If you have signs and symptoms of mitral valve regurgitation, you may need several diagnostic tests. But first your doctor will ask you about your general health, including your symptoms, prior tests and history of heart disease in your family.
Next, your doctor performs a physical examination. He or she listens to your heart sounds with a stethoscope. Mitral valve regurgitation usually produces a heart murmur. The murmur is the sound of blood leaking backward through the mitral valve.
With this information, your doctor decides which tests to request so that he or she can make a diagnosis and develop a treatment plan. You may be referred to a cardiologist — a doctor who specializes in the study of the heart and its function. Common tests used to diagnose heart valve problems include:
Treatments and drugs
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 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.
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:
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
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.
Lifestyle and home remedies
To improve your quality of life if you have mitral valve regurgitation, your doctor may recommend that you:
If you're a woman with mitral valve regurgitation, discuss family planning with your doctor before you become pregnant, because your heart works harder during pregnancy. How a heart with mitral valve regurgitation tolerates this extra work depends on the degree of regurgitation and how well your heart pumps. Should you become pregnant, your cardiologist and obstetrician need to evaluate you throughout your pregnancy, labor and delivery, and after delivery.
Because rheumatic fever is a risk factor for developing mitral valve regurgitation, if you have a severe sore throat you should see a doctor. Untreated strep throat can lead to rheumatic fever. Fortunately, strep throat is easily treated with antibiotics.
If you have high blood pressure, it's important to make sure it's well controlled to prevent mitral regurgitation.
If you have an abnormal valve, such as mitral valve prolapse, it's important to seek medical care if you develop a fever or signs or symptoms of an infection of your heart tissue (endocarditis).
If you have mitral valve regurgitation, talk to your doctor about the frequency of follow-up examinations, and have your doctor regularly check the amount of regurgitation through regular physical examinations and follow-up echocardiograms when needed.
Last Updated: 2011-09-15
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