Mitral Valve Regurgitation
mitral valve regurgitation: patients' guide
Mitral valve regurgitation (MVR), also known as mitral insufficiency or mitral incompetence, is one of the most common heart valve conditions. It occurs when the mitral valve—the valve that separates the left atrium from the left ventricle—does not close properly. As a result, blood leaks backward into the left atrium each time the left ventricle contracts.
This leakage can cause the heart to work harder to pump blood effectively, and over time, may lead to enlargement of the heart, atrial fibrillation, pulmonary hypertension, heart failure, or other serious complications.
Mitral regurgitation can be acute (sudden, often due to a heart attack or ruptured valve tissue) or chronic (developing slowly, often due to valve degeneration, rheumatic heart disease, or congenital abnormalities). It can also range from mild (causing few or no symptoms) to severe (requiring surgery or transcatheter intervention).
Understanding this condition, its signs, diagnostic pathways, and treatment options is crucial for patients, caregivers, and anyone at risk of developing heart valve disease.
Mitral regurgitation symptoms vary depending on severity and whether the condition develops gradually or suddenly.
Common Symptoms:
Shortness of breath (dyspnoea), especially during exertion or when lying flat
Fatigue or reduced exercise tolerance
Palpitations due to irregular heart rhythms such as atrial fibrillation
Swelling of ankles, feet, or abdomen (oedema) from heart failure
Cough, often worse at night or when lying down
Rapid heartbeat or feeling of fluttering in the chest
Symptoms of Acute Severe Mitral Valve Regurgitation:
Sudden, severe shortness of breath
Low blood pressure or shock
Pulmonary oedema (fluid in the lungs), requiring emergency care
Asymptomatic Phase:
In many patients, particularly with mild or moderate regurgitation, the condition may remain silent for years, discovered only during a routine heart examination when a murmur is detected.
You should seek medical advice if you experience:
Persistent or unexplained shortness of breath
Fatigue that interferes with daily life
Irregular or rapid heartbeat
Swelling in legs or abdomen
History of rheumatic fever or known heart valve problems
A family history of valvular heart disease
Emergency care is needed if you develop sudden severe shortness of breath, chest pain, or fainting.
1. Medical History and Physical Exam
Listening with a stethoscope may reveal a holosystolic murmur at the heart’s apex.
Doctors check for signs of heart enlargement, fluid retention, or irregular rhythms.
2. Echocardiography (Echo)
Transthoracic echocardiography (TTE): First-line test to assess severity of regurgitation, valve anatomy, and heart function.
Transoesophageal echocardiography (TOE): Provides more detailed images, especially before surgery or transcatheter procedures.
3. Electrocardiogram (ECG)
Detects arrhythmias such as atrial fibrillation.
4. Chest X-ray
May show enlarged heart chambers or pulmonary congestion.
5. Cardiac MRI
Helpful for precise quantification of regurgitant volume and ventricular function.
Mitral reurgitation treatment depends on symptoms, severity, heart function, and underlying cause.
1. Watchful Waiting / Monitoring
For mild or moderate regurgitation, regular follow-up with echocardiograms.
Monitoring of left ventricular size and function is crucial.
2. Medications
Diuretics to relieve fluid retention
Beta-blockers, ACE inhibitors, ARBs for heart failure management
Anticoagulants in patients with atrial fibrillation to prevent stroke
Medications do not cure MVR but control symptoms.
3. Surgical Options
Mitral valve repair (preferred when possible): preserves native valve, improves outcomes.
Mitral valve replacement (mechanical or bioprosthetic valve): required when repair is not feasible.
4. Transcatheter Options
MitraClip (Transcatheter Edge-to-Edge Repair, TEER): Minimally invasive option for patients unsuitable for open surgery.
Living with mitral valve regurgitation
Regular follow-up with a cardiologist and echocardiograms.
Lifestyle modifications:
Heart-healthy diet (low salt, balanced nutrition)
Regular exercise as tolerated
Avoiding smoking and excess alcohol
Strict adherence to medications.
Management of atrial fibrillation or hypertension if present.
Patients with prosthetic valves may need lifelong anticoagulation (warfarin).
Dental hygiene is important to reduce risk of endocarditis.
Prognosis depends on severity, timely intervention, and overall heart function.
Patients with mild regurgitation often live normal lives with little impact.
Severe untreated regurgitation can lead to heart failure, pulmonary hypertension, and reduced survival.
Surgical repair or replacement dramatically improves long-term outcomes when performed before irreversible heart damage.
- Mitral Valve Regurgitation is one of the most common heart valve disorders worldwide.
- It can be primary (due to valve disease) or secondary (due to left ventricular dysfunction).
- Many people have mild regurgitation without symptoms.
- Echocardiography is the gold standard for diagnosis and monitoring.
- Untreated severe Mitral Valve Regurgitation can cause heart failure and arrhythmias.
- Mitral valve repair is usually preferred over replacement when possible.
- Transcatheter options like MitraClip are available for high-risk patients.
- Surgery is ideally performed before symptoms or severe heart dysfunction develop.
- Regular monitoring is essential even in mild cases.
- With modern treatments, prognosis has greatly improved.
- How severe is my mitral valve regurgitation?
- Do I need surgery or can I be monitored?
- How often should I have follow-up echocardiograms?
- What symptoms should I watch for that mean my condition is getting worse?
- What are the risks and benefits of mitral valve repair versus replacement?
- Am I a candidate for minimally invasive or transcatheter procedures?
- Will I need to take blood thinners long-term?
- How will this condition affect my daily life and exercise?
- Are there lifestyle changes I can make to protect my heart?
- What is my long-term outlook with and without surgery?
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