Mitral valve regurgitation is a condition in which the mitral valve of the heart does not close properly. When this happens, each time the heart beats or contracts, some of the blood leaks backward into a heart chamber called the left atrium. This condition makes the heart work harder to pump blood throughout the body.

Causes of mitral valve regurgitation

Mitral valve regurgitation can be caused by:

• Rheumatic fever
• A congenital heart defect
• Endocarditis (infection of the mitral valve, causing damage)
• Age-related degeneration
• Damage to the tissue cords that tie the valves to the heart’s wall
• Mitral valve prolapse
• Prior heart attacks
• High blood pressure

Mitral valve regurgitation can weaken the heart, leading to heart failure, atrial fibrillation and pulmonary hypertension.

Symptoms of mitral valve regurgitation

Symptoms of mitral valve regurgitation can include:

• Fatigue, especially during times of increased activity
• Heart palpitations
• Shortness of breath
• Cough
• Swollen feet or ankles

Symptoms may worsen with exertion.

How Ohio State diagnoses mitral insufficiency

Mitral valve regurgitation may be suspected if a physician detects abnormal sounds, such as a heart murmur, through a stethoscope. To further define the nature and extent of the valve disease, physicians may use tests including:

• Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
• Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
• Transesophageal echocardiogram (TEE) – A test to provide an image of heart structures; a small transducer (like a microphone) is passed down the esophagus to produce the image.
• Exercise stress test – A test performed on a treadmill or stationary bicycle to measure heart, lung and muscle function during physical activity. You are attached to an electrocardiogram (ECG/EKG) to record electrical activity of the heart.

How Ohio State treats mitral valve regurgitation

Medications

Drugs prescribed to relieve the symptoms of mitral valve regurgitation include diuretics and drugs used to lower blood pressure. High blood pressure can cause mitral valve regurgitation, or aggravate its severity, so lowering blood pressure is often a way to reduce its severity, decrease symptoms and avoid or delay the need for surgery.

Surgery and procedures

Many people who have mitral valve regurgitation may not require treatment; it depends on severity. Those with mild mitral valve regurgitation rarely require specific treatment. If you have this condition, your physician should regularly monitor you to make sure it does not worsen, or permanently damage or weaken your heart to the point where surgery would not be necessary.

Mitral valve repair is the preferred treatment for mitral valve regurgitation. Mitral valve replacement may be an option when repair is not feasible.

Both mitral valve repair and replacement require open heart surgery. At Ohio State's Wexner Medical Center, minimally invasive surgery is frequently performed instead. This involves a smaller incision and usually a shorter recovery time. In the future, some types of mitral valve regurgitation may be repaired without the need for open heart surgery. Studies are under way to develop approaches that could be performed in the cath lab to repair a defective or leaky valve.