What Is Mitral Valve Regurgitation?

When your heart pumps blood, it’s supposed to follow a specific path in one direction. But sometimes, it goes the wrong way.

Mitral valve regurgitation is when your blood isn’t going where it should. With this condition, some of it leaks backward instead of flowing out to the rest of your body.

You may feel tired and out of breath if you have it. You may also have higher blood pressure and a buildup of fluid in your lungs.

Your doctor may refer to it by one of its other names, which include:

Mitral valve insufficiency or mitral insufficiency

Mitral regurgitation

Mitral valve incompetence or mitral incompetence

Leaky heart valve

They can confirm whether you have a mild case and might not even need treatment, or a more serious situation that will need medication or surgery.

There are two types of mitral valve regurgitation, depending on the cause, including:

Both types of mitral valve regurgitation can be either acute (developing suddenly) or chronic (developing gradually over time).

Mitral valve regurgitation is when your blood isn’t going where it should. With this condition, some of it leaks backward instead of flowing out to the rest of your body. You may feel tired and out of breath if you have it. You may also have higher blood pressure and a buildup of fluid in your lungs. (Photo credit: BSIP/Jacopin/Medical Images)

Before you understand the details of how blood can flow the wrong way in one part of your heart, you need to know how things should work.

The heart has four chambers: the left and right atrium on top and, below them, the left and right ventricles. As your heart beats, it draws blood from the body into the right atrium. This chamber sends it down to the right ventricle. From there, your blood is pumped to the lungs to pick up oxygen.

When that oxygen-rich blood goes back to the heart, the left atrium takes it in and passes it down to the left ventricle. That chamber contracts, or squeezes, to send it to your body.

You have a passageway between the left atrium and the left ventricle. That is the mitral valve.

Mitral Valve Insufficiency

The mitral valve is supposed to be a one-way passage between your heart's left atrium and left ventricle. It has two flaps, called leaflets. With each contraction of your heart, these leaflets open to allow blood to flow through, and then they close tightly. Along with the other three valves in your heart, the opening and closing of your mitral valve helps keep your blood flowing properly.

But sometimes, the mitral valve doesn’t seal properly when it closes. This creates a leak that allows blood to flow backward through it, returning to the left atrium.

When this happens, you have mitral valve regurgitation. A small leak may not cause noticeable problems, but larger leaks force your heart to work harder to pump the right amount of blood. Over time, this can lead to serious complications, including heart failure and abnormal heart rhythms, also called arrhythmias. Mitral valve regurgitation can also be fatal.

Some people with this condition may not feel any symptoms, while others may have chest pain, shortness of breath, an irregular heartbeat, or dizziness, among other things.

If you have mild regurgitation you may not notice any symptoms. But if the condition worsens, you might have:

Some other things you or your doctor may notice:

You get very tired more easily.

You have a heart murmur (blood whooshing or swishing around).

You have low blood pressure.

You might faint.

Some symptoms signal a medical emergency. Call 911 if you have any of the following symptoms, which can be a sign of acute heart failure:

Tightness in your chest

Feeling of suffocation

Heavy breathing

Breathing that's challenging when you're lying down

Low blood oxygen

Numerous health conditions can cause mitral valve regurgitation. They include:

In addition to the above causes, your risk of developing mitral valve regurgitation rises if you:

Mitral Valve Regurgitation Complications

Mitral valve regurgitation can lead to very serious and even life-threatening conditions. These include:

Doctors usually find a problem with your heart valve by listening to your heart and lungs with a stethoscope. If blood is leaking back into your left atrium, it will produce a murmur or a whooshing sound. That will lead to several tests to determine whether you have mitral valve regurgitation or another condition that could be causing the murmur. These tests include:

You may get follow-up tests from time to time, depending on your case.

Mitral Valve Regurgitation Stages

When you’re diagnosed, your doctor will determine the current stage of your mitral valve regurgitation. The stage depends on a few different factors:

The severity of the disease

Your symptoms

The structure of your mitral valve

How blood flows through your heart and lungs.

The four stages are:

The answer is different for different people. It can be a slow-moving disease, or it can get worse more quickly. Doctors can tell how far your disease has progressed by measuring how much blood leaks through your mitral valve. How well you will do depends on a few different factors, including:

The cause of your mitral valve regurgitation

The stage of your disease

The severity of your disease

How long you have had mitral valve regurgitation

Mitral Valve Regurgitation Treatment

If you have a mild case, you might need no treatments at all. Your doctor will still want to keep a watchful eye on you with regular checkups. Here’s a likely follow-up schedule:

If you have a mild case, expect to undergo an echocardiogram test every 3-5 years.

If you have a moderate case, you should have an echo every year or two.

If you have a severe case, you should see your doctor at least every 6-12 months.

Medications

Medications can’t actually fix a valve problem, but they can target other things that make regurgitation worse or conditions that arise as complications of your mitral valve regurgitation. These include:

In more severe cases, you might need an operation.

Not everyone with mitral valve regurgitation will require surgery, but if your disease doescontinue to get worse over time, a procedure may become necessary. The decision about whether to fix it and what type of procedure to use depends on several things:

The severity of your valve problem

Your age and health

Whether you need surgery for other heart conditions

Surgery for mitral valve regurgitation is done to repair or replace your mitral valve. Your surgeon attempts to fix your mitral valve by:

Patching holes in your valve.

Reconnecting the leaflets of your valve.

Removing excess valve tissue to allow your valve to close properly.

Replacing the string-like chords that support your mitral valve with artificial chords.

Separating the leaflets of your valve if they have become connected.

Specific repair procedures include:

Annuloplasty, in which your surgeon tightens or reinforces your mitral valve by permanently placing a flexible mesh, metal, or plastic ring around your valve to help it open and close properly.

Valvuloplasty, which is done if your valve has a narrowed opening. Your doctor inserts a catheter into an artery and guides it to your mitral valve. Once there, a balloon is inflated, widening the opening of your valve.

Mitral valve clip, also called transcatheter edge-to-edge repair (TEER), in which a catheter is guided to your heart and used to attach a clip to your mitral valve. The clip helps your valve to close properly.

Mitral valve replacement

If your mitral valve can’t be repaired, it will need to be replaced. Your new valve will be either:

Mechanical, or made of carbon and steel, which typically lasts 20-30 years, so you may not need a second surgery. However, they increase your risk of blood clots, which require you to take blood thinners for the rest of your life.

Biological, made of tissue taken from pigs, cows, or in rare cases humans. These are less durable than mechanical valves and may need replacement after 10-15 years. They don’t raise your risk of blood clots, so you won’t need to take blood thinners.

Replacement surgery usually requires open heart surgery. However, you may qualify for a minimally invasive procedure called transcatheter mitral valve repair or replacement (TMVR). Ask your doctor if this is an option for you.

Open-heart surgery

This is the most common way to repair or replace your heart valve.

You may need it even if you don’t have any symptoms. That’s because your doctor might decide this will prevent long-term heart damage.

Usually, doctors prefer to repair the valve instead of replacing it. It all depends on your particular case, though.

If you get a replacement, the valve may be a man-made device or it could come from a pig, a cow, or someone who signed up for organ donation before they died.

During open-heart surgery, you’ll be given something so you won’t be awake. You will not feel pain during the procedure.

Other types of surgery

Sometimes, doctors will decide someone is too sick to have open-heart surgery. They have other options.

Your doctor could recommend what’s called “minimally invasive heart surgery.” Instead of opening up your chest, your doctor creates one or more small cuts and works through them.

Depending on the kind of procedure, the surgeon may use a robotic arm or a long, flexible tube called a thoracoscope that holds a tiny video camera.

Like open-heart surgery, you’ll be given something so you won’t be awake or feel any pain while it’s going on.

This is a newer field of surgery, so you want to ask your doctor about the experience level of the team and the hospital in doing this type of procedure.

Catheters

Your doctor may not think you’re healthy enough for surgery or that the fix can be made with a procedure that's easier on you. Some hospitals are able to use catheters to repair or replace the valve. Several types of procedures use these small, flexible tubes.

Your doctor inserts the catheter into a blood vessel in your leg and guides it toward your heart. It may hold a clip at the end to repair your valve. Or it may carry a balloon that’s inflated at the right spot to make room for a replacement valve.

During these procedures, you are given something to help you stay calm, but you may be awake.

Before and after your hospital stay

It’s a good idea to plan for your first week of meals before you go into the hospital. You can make them ahead of time and freeze them. That makes it easy for a relative or friend to warm up the food for you.

Arrange for someone to drive you to and from the hospital while you’re recovering.

Ask someone to listen to the doctor’s instructions when you’re sent home from the hospital. You may not be thinking as clearly as normal because of the surgery. You may even want to consider home health care during the early stages of your recovery.

You’ll need to remember the medication and the proper doses you need to take after surgery. Use a chart or tracker to help you keep up your schedule.

No matter what stage your regurgitation is at, there are things you can do at home to manage it. Your doctor may bring up many of the following:

Support groups

You may find you need help in learning to live with this condition. Maybe you just need someone to talk to.

There are support groups that can help you handle the emotional side of a diagnosis. Family and friends are often a good place to turn to for support.

You can also ask your doctor about other support options in your city. They often have people on staff who can help to get you started.