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Mitral Valve Regurgitation

Mitral valve regurgitation (also known as mitral regurgitation, mitral insufficiency or mitral incompetence) is a heart condition where the mitral valve doesn't close all the way and, as a result, leaks. The mitral valve is the one-way opening that controls the blood flow from the upper left chamber of your heart to the lower left chamber.

  • When the mitral valve is unable to close completely, blood flows back up (regurgitates) into the upper chamber when your heart contracts.
  • Excess blood in the upper chamber can back up into the lungs, in addition to creating a strain on the pumping chambers of the heart that causes them to enlarge.
  • Because the leaking mitral valve causes backward flow of blood, not enough blood flows forward out of the heart to meet the needs of the body. So the heart must work even harder to keep up.

Though many people who have mitral regurgitation have no symptoms, if left untreated, it can result in arrhythmia (abnormal heart rhythm), congestive heart failure or blood clots, which can cause a stroke

Mitral regurgitation risk factors

  • Age. Mitral regurgitation can occur as you get older and the mitral valve starts wearing out naturally.
  • Other heart conditions. Mitral regurgitation can be caused by many other heart conditions, including one or more of the following:
    • Heart attack
    • Heart infections (such as endocarditis, an infection of the lining of your heart)
    • Mitral valve prolapse
    • Abnormality of the heart muscle
    • Rheumatic heart disease (a result of an untreated strep infection, which is rare in the United States)
    • Congenital heart defects (present at birth)
    • Use of an appetite suppressant banned by the FDA: If you used a diet pill called Fen-Phen before it was banned in the U.S. in 1997, you are also at risk for mitral regurgitation.

Symptoms of mitral regurgitation

Mitral regurgitation symptoms often develop slowly. You may experience one or more of the following symptoms:

  • Heart murmur (heard through a stethoscope, it is a blowing, whooshing or grating sound that the blood makes as it moves through the heart)
  • Chest pain
  • Heart palpitations (irregular, pounding or skipped heartbeats)
  • Shortness of breath or rapid breathing
  • Feeling exhausted or light-headed
  • Coughing
  • Swollen feet or ankles
  • Frequent urination (especially at night)

You may not have any mitral regurgitation symptoms. Being symptom-free, however, does not mean that you may not need treatment for this serious condition.

How can I get help for mitral regurgitation?

Call your primary care doctor if you are experiencing any of the symptoms of mitral regurgitation. After examining you, your primary care doctor may send you to a cardiologist for further evaluation and treatment.

If you are experiencing severe shortness of breath or chest pain, seek immediate medical care by calling 911 or going to an emergency room for evaluation.

Care for mitral regurgitation at Rush

At the Rush Center for Adult Structural Heart Disease, you will be examined, undergo diagnostic tests and meet with a team of heart specialists, including a cardiologist and a cardiac surgeon, to learn more about your condition and your treatment options. 

Diagnosis

To get a close look at the structure of your heart and how it is functioning, you may need one or more of the following diagnostic tests:

  • Echocardiogram: Using sound waves, this noninvasive test shows the structure of your heart and how it is functioning.
  • Transesophageal echocardiogram: This test involves inserting a tube down your esophagus to get a closer look at your heart using sound waves.
  • Electrocardiogram (ECG): This test measures the electrical activity of your heart, including arrhythmias (irregular heartbeats).
  • Imaging: You may have a chest X-ray, MRI and/or CT scan to get a more precise view of the structure of your heart and lungs.
  • Cardiac catheterization: If your condition is severe, your doctor may order cardiac catheterization, a minimally invasive procedure using a catheter (a thin, flexible tube) that is guided to the heart. A dye is injected through the catheter that enhances X-ray images of the arteries in your heart. It shows how well your heart is functioning as well as the pressure inside the chambers of your heart.

Treatment

Treatment for mitral regurgitation depends on your overall condition, the cause of your mitral regurgitation and the symptoms you are experiencing, if any.

Nonsurgical options

  • Watchful waiting: If your mitral regurgitation is mild and you have no symptoms (or your symptoms are mild), your heart specialist may recommend keeping a close watch on your condition until there is a change.
  • Medication: Your heart specialist may prescribe medications to treat symptoms or conditions caused by mitral regurgitation. Though the medication does not change the fact that your mitral valve is not closing properly, it can help relieve the strain on your heart and help you feel better.

Procedures

If your heart is enlarged or functioning poorly, or your symptoms are severe, your team may repair or replace your mitral valve. Depending on your condition and other factors, you may have one of the following procedures:

  • Open heart surgery: Your heart surgeon may perform open heart surgery to repair your mitral valve so that it closes properly. If your mitral valve is no longer able to function, your heart surgeon can replace it with a biological or synthetic valve. Sometimes, this procedure can be done using minimally invasive techniques. Your surgeon will talk to you about which approach is right for you.
  • Robotic-assisted minimally invasive heart surgery: With the da Vinci robotic surgery system, your heart surgeon has the enhanced maneuverability needed to repair your mitral valve through small incisions. You will likely have less pain and recover more quickly than you would with open heart surgery.
  • Catheter-based procedures: If heart surgery is not an option, you may be eligible for a procedure using a device called MitraClip. Your cardiologist guides a catheter (a thin, flexible tube) to your mitral valve, then attaches a clip to the mitral valve, which helps it close better. Interventional cardiologists at Rush have been leaders in clinical trials that helped bring this innovative nonsurgical approach to patients.

Why choose Rush for mitral regurgitation care

  • Team-based approach: At the Rush Center for Adult Structural Heart Disease, each patient meets with a team of specialists — including an interventional cardiologist and a cardiac surgeon — at the same time to ensure coordinated, comprehensive care.
  • Leaders in care: Cardiologists at Rush have been leaders in bringing innovative nonsurgical approaches to mitral valve repair, including MitraClip, to patients. Through clinical trials, our patients may be able to receive new treatments before they are widely available.
  • Collaboration and convenience: Some of the procedures used to treat mitral regurgitation take place in Rush's interventional platform, where procedures are centralized to allow specialists to collaborate more easily and ensure convenience for patients and families.

Departments and programs that treat this condition