Mitral Regurgitation

What are heart valves?

There are four valves in the heart. They allow blood to be directed around the heart and when working normally ensure the blood flows in one direction. They open and close with every heartbeat – that’s 100,000 times a day! 

Heart Valves

What is a murmur?

A murmur is the sound blood makes as it travels through a valve which is thickened or leaking.

What is the mitral valve? 

The mitral valve is a valve situated on the left hand side of the heart. It is a one way valve that allows blood to move from the top chamber of the heart (left atrium) to the bottom chamber of the heart (the main pump – the left ventricle). 

What is mitral regurgitation? 

Mitral regurgitation is a condition where this one-way valve is not working correctly. 

Because the valve is unable to close tightly, a leak of blood occurs when the main pumping chamber of the heart contracts (left ventricle), allowing blood to pass back across the valve, back into the top heart chamber (left atrium).

What causes mitral regurgitation? 

There are a number of causes of mitral regurgitation. The two most common causes are valve degeneration or mitral valve prolapse (age related wear and tear, or a ‘floppy’ mitral valve) and ‘secondary’ mitral regurgitation (due to stretching of the heart). Other causes include:

• Damage to the heart valve following heart valve infection (endocarditis) 
• Congenital disorders (people born with an abnormal heart valve) 
• Heart failure or following a heart attack.

What are my treatment options? 

Mitral regurgitation is a chronic (long term) condition. It can be graded into three categories: mild, moderate and severe. 

Mild or moderate mitral regurgitation does not usually cause symptoms or any strain on the heart. 

Regardless of the severity of mitral regurgitations, if you have no symptoms, it is likely that the Heart Valve Team will keep you under review with a clinic visit and echocardiogram (echo or cardiac ultrasound) intermittently as the valve disease can progress. Patients with mitral regurgitation are often followed up for many years without any symptoms. Follow up intervals will be determined by the Valve Team looking after you and depends on the severity and progression of your mitral regurgitation. Patients with mild mitral regurgitation usually do not require long-term monitoring. Occasionally on-going monitoring of this type of valve disease is not required and the Heart Valve Team will discuss the reasons for this with you.

Sometimes mild mitral regurgitation may be considered normal and may not need surveillance. 

There are different clinics including nurse-led, sonographer-led or doctor-led. You will be advised which clinic to attend. There will always be the opportunity to ask about your condition. 

If your mitral valve is severely leaky and you develop symptoms, the heart becomes stretched or weakened so you may referred for surgery. 

Before seeing a surgeon, you will have a series of tests to decide whether you are suitable for either a mitral valve replacement, mitral valve repair, or transcatheter intervention. 

Valve repair: This can be surgical or transcatheter (keyhole).  The existing valve is modified to prevent it leaking. 

Valve replacement: This is a surgical procedure. The existing valve is removed and replaced with either a tissue or mechanical valve. 

Most people with mitral regurgitation will  not require any treatment and will just require regular monitoring of their condition.

What tests will I need? 

Most people with mitral regurgitation will have an ECG and an echocardiogram. Other tests as outlined below may also be performed. 

Electrocardiogram (ECG)

Stickers are placed on the chest and the electrical activity of the heart is recorded. 

Echocardiogram (Echo or cardiac ultrasound)

During this test an ultrasound probe is place on the chest and moving pictures of the heart are produced. The test takes around 30 minutes. 

Angiogram

This is an x-ray dye test of your heart arteries performed under local anaesthetic. 

Cardiopulmonary exercise test (CPX) 

An exercise test performed on the treadmill or bicycle to assess how your heart and lungs respond to exercise. You will be asked to exercise wearing a mouthpiece and your heart and blood pressure will be monitored. 

Transoesophageal echocardiogram (TOE) 

This is a day case procedure similar to an endoscopy which takes place under sedation. A probe is passed into the gullet and detailed pictures of the heart are obtained using ultrasound.

Lifestyle 

As with any type of heart disease, it is important that you follow a healthy diet and keep your weight within a normal range. 

Smoking

If you smoke, it is advisable that you stop. Your GP can guide you to support available to help you stop smoking. 

Exercise

For most patients there is no limitation for exercising. You can discuss this with your healthcare professional.

Pregnancy

If you are planning to get pregnant you should discuss this with your healthcare professional first and let them know immediately if you become pregnant.

Endocarditis 

Bacteria can enter the blood stream via many sources, most commonly the mouth and skin. In patients with abnormal valves these bacteria can attach to the heart valves causing infection known as endocarditis. It is therefore important to take good care of your teeth by brushing your teeth twice a day and visiting your dentist for regular check-ups (at least once a year). If you have toothache or an abscess it is important that you get treated for this quickly. Make sure you tell your dentist you have a heart valve condition.

Symptoms

If you experience any new symptoms between clinic appointments then it is important that you let your healthcare professional know.

You can visit the Leeds Specialist Valve Service web page for more information