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Mitral valve disease

Overview

In mitral valve disease, the mitral valve, which is located between your left heart chambers (left atrium and left ventricle), doesn't work properly.

Types of mitral valve disease include:

Mitral valve regurgitation

In this condition, the flaps (leaflets) of the mitral valve don't close tightly, causing blood to leak backward into the left atrium of your heart. If not treated, it can result in heart muscle damage.

This condition is commonly caused by mitral valve prolapse, in which the leaflets bulge back into the left atrium as your heart contracts.

Mitral valve stenosis

In this condition, the flaps of the mitral valve become thick or stiff, and they may fuse together. This results in a narrowed valve opening and reduced blood flow from the left atrium to the left ventricle.

Treatment for mitral valve disease depends on the severity of your condition and whether your condition is becoming worse. Your doctor may eventually recommend that you have surgery to repair or replace your mitral valve.

Mitral valve prolapse and regurgitation

The mitral valve separates the two chambers (atrium and ventricle) of the left side of the heart. In mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) into the left atrium like a parachute during the heart's contraction. Sometimes mitral valve prolapse causes blood to leak back into the atrium from the ventricle, which is called mitral valve regurgitation.

Mitral valve prolapse and regurgitation

The mitral valve separates the two chambers (atrium and ventricle) of the left side of the heart. In mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) into the left atrium like a parachute during the heart's contraction. Sometimes mitral valve prolapse causes blood to leak back into the atrium from the ventricle, which is called mitral valve regurgitation.

Normal heart and heart with mitral valve stenosis

Mitral valve stenosis, shown in the heart on the right, is a condition in which the heart's mitral valve is narrowed. This abnormal valve doesn't open properly, blocking blood flow coming into your left ventricle, the main pumping chamber of your heart. A normal heart is shown on the left.

Symptoms

Some people with mitral valve disease might not experience symptoms for many years. Signs and symptoms of mitral valve disease may include:

  • Abnormal heart sound (heart murmur) heard through a stethoscope
  • Fatigue
  • Shortness of breath, particularly when you have been very active or when you lie down
  • Swelling of your ankles and feet
  • Irregular heartbeat

When to see a doctor

If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest mitral valve disease, see your doctor.

Causes

Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (leaflets or cusps) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart to your body.

In mitral valve disease, the mitral valve between the upper left heart chamber (left atrium) and the lower left heart chamber (left ventricle) doesn't work properly. It may not be closing properly, which causes blood to leak backward to the left atrium (regurgitation), or the valve may be narrowed (stenosis).

Mitral valve disease has many causes. Some forms of mitral valve disease can be present at birth (congenital heart defect).

Mitral valve regurgitation can be caused by problems with the mitral valve, also called primary mitral valve regurgitation. Mitral valve regurgitation is often caused by mitral valve prolapse, in which the mitral valve flaps (leaflets) bulge back into the left atrium. Diseases of the left ventricle can lead to secondary mitral valve regurgitation.

Mitral valve stenosis is often caused by rheumatic fever, which is a complication of a strep infection that can affect the heart.

Chambers and 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 out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Risk factors

Several factors can increase your risk of mitral valve disease, including:

  • Older age
  • History of certain infections that can affect the heart
  • History of certain forms of heart disease or heart attack
  • History of use of certain drugs
  • Heart conditions present at birth (congenital heart disease)

Complications

Mitral valve disease can cause many complications, including:

  • Irregular heart rhythms in the upper heart chambers (atrial fibrillation)
  • High blood pressure that affects the blood vessels in the lungs (pulmonary hypertension)
  • Blood clots
  • Heart failure
  • Stroke

Diagnosis

Your doctor may evaluate your signs and symptoms and conduct a physical examination. In a physical examination, your doctor will likely listen for a heart murmur, as this can be a sign of a mitral valve condition. Your doctor may order several tests to diagnose your condition.

Tests may include:

  • Echocardiography. 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, your heart valves and the blood flow through your heart. It can also help doctors see the pressure in blood vessels in your lungs. An echocardiogram helps your doctor get a close look at the mitral valve and how well it's working. Doctors may also 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 the tube leading from your mouth to your stomach (esophagus). This test allows doctors to have a closer look at the mitral valve than is possible with a regular echocardiogram.

  • Electrocardiogram (ECG). In this test, wires (electrodes) attached to 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. A chest X-ray can help your doctor to determine whether the heart is enlarged, which can indicate certain types of heart valve disease. A chest X-ray can also help doctors determine 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.
  • 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 disease, but it may be used if other tests haven't diagnosed the condition or to check to see if coronary artery disease is present. Doctors may use this test to plan the appropriate treatment for your condition.

    In this procedure, a doctor threads a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart and injects dye through the catheter to make the artery visible on an X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.

Treatment

Mitral valve disease treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse.

A doctor trained in heart disease (cardiologist) will provide your care. If you have mitral valve disease, consider being evaluated and 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.

Your doctor may suggest monitoring your condition with regular follow-up appointments. Your doctor may also recommend making healthy lifestyle changes and taking medications to treat symptoms. You might need to take blood thinners to reduce the risk of blood clots if you have a certain irregular heart rhythm called atrial fibrillation.

Your mitral valve may eventually 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 which surgeons use robotic arms to conduct the procedure.

Surgery options include:

Mitral valve repair

Your doctor may often recommend mitral valve repair when possible, as it preserves your heart valve and may preserve heart function. To repair a mitral valve, surgeons may patch holes in a valve, reconnect valve flaps (leaflets), separate valve leaflets that have fused, replace the cords that support the valve, or remove 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.

The mitral valve may be repaired using a long, thin tube (catheter) and clips, plugs or other devices. 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 mitral 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 catheter procedure, doctors may repair a previously replaced mitral valve that is leaking by inserting a device to plug the leak.

Doctors may also conduct a procedure using a long, thin tube (catheter) to repair a mitral valve with a narrowed opening. In this procedure, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the valve.

A doctor then inflates the balloon, which expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed. You may need additional procedures to treat the narrowed valve over time.

Mitral valve replacement

If the mitral valve can't be repaired, surgeons may perform 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 will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve 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.

Minimally invasive heart surgery

In one type of minimally invasive heart surgery, surgeons make small incisions in the side of your chest, between your ribs, to reach your heart. Surgeons conduct the procedure using long instruments.

Minimally invasive heart surgery

In one type of minimally invasive heart surgery, surgeons make small incisions in the side of your chest, between your ribs, to reach your heart. Surgeons conduct the procedure using long instruments.

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

In mitral valve repair, a doctor removes the portion of the mitral valve that doesn't close properly, as shown in the top image. Then a doctor 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. The illustration shows mitral valve repair using robotic instruments.

Repair of previously replaced valve

Doctors may repair a previously replaced mitral valve that is leaking by inserting a device to plug the leak.

Preparing for an appointment

If you think you have mitral valve disease, 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 heart 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 to your doctor about challenges you might face in getting started.
  • Write down a list of questions to ask your doctor.

For mitral valve disease, 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 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

Questions your doctor is likely to ask include:

  • 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?

Lifestyle and home remedies

You'll have regular follow-up appointments with your doctor to monitor your condition.

Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, 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. Aim to keep a healthy weight. If you're overweight or obese, your doctor may 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 doctor about resources to help you quit smoking. Joining a support group may be helpful.

For women with mitral valve disease, it's important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy. You'll likely require close monitoring by your doctor during pregnancy.

Coping and support

If you have mitral valve disease, 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.

Last updated: March 3rd, 2017

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