Mitral Valve Disease

Mitral valve disease affects the valve between the left upper and lower chambers of your heart. This condition can range from mild, with no symptoms, to severe, potentially leading to serious complications like heart failure if left untreated.

Table of contents

• What is Mitral Valve Disease?
• Types of Mitral Valve Disease
• Causes and Risk Factors
• Signs and Symptoms
• How It Is Diagnosed
• Treatment Options
• Living With Mitral Valve Disease

What is Mitral Valve Disease?

Mitral valve disease is a problem with the valve located between the left heart chambers. The upper left heart chamber is called the left atrium (the area where blood from your lungs enters). The bottom left heart chamber is called the left ventricle (the main pumping chamber of the heart).^[1]

The mitral valve controls blood flow from the left atrium into the left ventricle. When the heart contracts, the mitral valve closes to prevent blood from backing up into the lungs. The valve has two strong flaps of tissue called leaflets or cusps. These flaps open and close in a coordinated rhythm to let blood flow out of your left atrium and into your left ventricle.^[2]

When your mitral valve becomes diseased or damaged, it cannot work as well as it should. Mild damage may cause no symptoms and no major problems. However, severe damage to your mitral valve can harm your heart over time and lead to serious problems like heart failure.^[2]

• Heart
• Left atrium
• Left ventricle

Types of Mitral Valve Disease

Mitral valve disease has three different forms. Each form affects your valve’s function in a slightly different way. Some people may have more than one form at the same time.^[2]

Mitral valve regurgitation is commonly known as a leaky valve. It is also sometimes called “mitral insufficiency.” Your valve’s flaps become pulled apart and cannot close all the way. This causes blood to leak backward into your left atrium. The mitral valve flaps may not close tightly, allowing blood to flow the wrong way through the valve.^[1]

Mitral valve stenosis occurs when the flaps of the mitral valve become thick or stiff, and they can fuse together. This narrows the valve opening, which reduces blood flow from the left atrium to the left ventricle. The narrowing makes it harder for blood to get through.^[1] When the valve does not open fully, it weakens the heart as it struggles to pump enough blood through the smaller valve opening.^[7]

Mitral valve prolapse occurs when the valve’s flaps become too stretchy and bulge into your left atrium. The flaps are enlarged, and the muscles supporting them are too long. Instead of closing evenly, one or both of the flaps collapse or bulge into the left atrium. This prevents your valve from closing as well as it should. It sometimes leads to regurgitation (leaky valve).^[2]

Causes and Risk Factors

Mitral valve disease can either be caused by a defect or abnormality in the mitral valve, or it can result from another disorder or condition. The disease can be acquired (it develops over time as you get older) or congenital (you were born with it).^[2]

Many people are born with congenital mitral valve disease, which can present as having only one valve flap instead of two. Other people develop mitral valve disease after birth. Some adults are affected suddenly due to an infection in their heart or a heart attack. Usually, though, adults develop mitral valve disease over time as the valve slowly deteriorates.^[2]

Several conditions and factors can contribute to mitral valve disease. Rheumatic fever is a serious complication of strep throat or scarlet fever that can cause scarring of the mitral valve. Mitral valve stenosis is typically caused by scarring from rheumatic fever. The disease and its symptoms usually appear 16 to 40 years after the episode of acute rheumatic fever.^[7]

Endocarditis is an infection affecting the heart valves or the inner surface of the heart. This infection typically occurs when bacteria or other germs in the mouth, intestinal tract, or urinary tract travel to the heart via the bloodstream and lodge in the heart. Hearts with defects or those that have been repaired are vulnerable to infection.^[4]

Other causes include heart attack, infection or trauma, abnormality of the heart muscle (called cardiomyopathy), congenital heart defects, radiation therapy, and heart rhythm disorders.^[3] Some forms of mitral valve prolapse have been associated with Marfan syndrome, a connective tissue condition where patients have long bones and very flexible joints.^[6]

Mitral valve disease affects people of all ages. One form, mitral valve prolapse, is more common among women. However, mitral valve prolapse seems more dangerous for men, who are more likely to have prolapse that leads to severe regurgitation.^[2]

Signs and Symptoms

Many people with mitral valve disease experience no symptoms, especially in the early stages. If you have mitral valve disease, you may not experience symptoms, or they can either come on suddenly or gradually worsen.^[3]

When symptoms do occur, they may include shortness of breath, especially when lying down or during physical activity. You may experience chest pain or feel like your heart is skipping a beat (called palpitations).^[3] Other symptoms include extreme fatigue, dizziness or feeling lightheaded, and coughing.^[6]

Additional signs that may appear include swelling of hands, arms, legs, or feet, unexplained weight gain, and fever. Some people may experience a rapid, fluttering heartbeat or an irregular heart rhythm. In rare cases, people may have trouble breathing after exercise or a racing heartbeat.^[6]

Most people with mitral valve prolapse do not have symptoms. When symptoms happen with prolapse, they may include shortness of breath, chest pain, extreme fatigue, heart palpitations, coughing, trouble breathing after exercise, or in rare cases, rapid heartbeat.^[6]

How It Is Diagnosed

To diagnose mitral valve disease, a health care professional examines you and asks questions about your medical history. The health care professional listens to your heart with a device called a stethoscope. A whooshing sound, called a heart murmur, may be a sign of a mitral valve condition. The mitral valve heart murmur is the sound of blood leaking backward through the valve.^[9]

Tests to diagnose mitral valve disease may include an echocardiogram. This test uses sound waves to create pictures of the heart in motion. It shows how blood moves through the heart and heart valves, including the mitral valve. An echocardiogram shows the structure of the mitral valve and blood flow in the heart. It can confirm a diagnosis of mitral valve disease and tell how severe the condition is.^[9]

A standard echocardiogram is done from outside the body. Sometimes, a more detailed echocardiogram is needed to get a closer look at the mitral valve. This type of echocardiogram is called a transesophageal echocardiogram. It is done from inside the body and creates pictures of the heart from inside.^[9]

An electrocardiogram (ECG or EKG) is a quick and simple test that measures the heart’s electrical activity. It shows how fast or how slowly the heart is beating. Sticky patches called sensors or electrodes are attached to the chest and sometimes the arms and legs. An ECG can show irregular heart rhythms related to mitral valve disease.^[9]

A chest X-ray is a picture of the heart and lungs. It can show whether the heart is enlarged, which can be a sign of certain types of heart valve disease. A cardiac MRI uses magnetic fields and radio waves to create detailed pictures of the heart. It might be done to determine the severity of mitral valve disease. Exercise tests or stress tests may also be performed to evaluate how the heart responds to physical activity.^[9]

Treatment Options

Treatment for mitral valve disease depends on the severity of the condition and whether it is worsening. Treatment options range from medications and lifestyle changes to surgical procedures.^[1]

Medications and Lifestyle Changes

Medications may be prescribed to help manage symptoms of mitral valve disease. These medications only treat the symptoms and do not address the underlying problem with your mitral valve. Medications can include blood thinners, diuretics (water pills) for fluid buildup in the legs and lungs, medicines to help the heart pump better, and drugs to control heart rhythm problems.^[3]

To help reduce heart failure symptoms caused by mitral valve disease, your doctor may suggest several lifestyle changes. These can include reducing salt intake, limiting alcohol, quitting smoking, and losing weight.^[22] Eating a heart-healthy diet high in fruits and vegetables and low in saturated fats can help prevent heart issues. Keeping your blood pressure under good control is especially important to slow the progression of mild or moderate mitral regurgitation.^[16]

Surgical Treatments

Sometimes, surgery is recommended to repair or replace the mitral valve. Surgical mitral valve repair is the treatment of choice for severe mitral valve disease. If mitral valve repair is an option for you, a surgical technique called an annuloplasty may be performed. This procedure typically involves the implantation of a device to tighten or replace the ring around the mitral valve so that the valve leaflets can close properly.^[13]

Mitral valve repair gives you the greatest probability for a safe and effective solution over time. In Germany, more than 50% of all mitral valve defects are now treated with a valve-preserving repair procedure. Almost all leaky valves caused by certain types of degeneration can be successfully repaired with surgery.^[14]

When valve repair is not possible, a new mechanical or tissue valve replacement can be done. The replacement valve can be made from metal (mechanical) or from animal tissue such as pig or cow, or from human donor tissue.^[5] Recent years have seen major advances in minimally invasive mitral valve surgery.^[14]

Transcatheter Procedures

Transcatheter edge-to-edge repair (TEER) is a minimally invasive procedure that may be an option for people with severe mitral regurgitation. Unlike surgery, this procedure does not require chest incisions and temporarily stopping the heart. A small implanted clip (called MitraClip) is attached to your mitral leaflets through a vein in your leg to help the valve close more completely. This helps restore normal blood flow through your heart.^[13]

The implantation of a mitral clip is the sole currently approved transcatheter technique of this type. In a recently published, randomized comparative clinical trial, it was found to be safer, but less effective, than surgery. For patients at high risk from surgery, and particularly those with severe heart failure, the implantation of a mitral clip is a safe and feasible treatment option.^[14]

Living With Mitral Valve Disease

If you have mitral valve disease, there are several things you can do to manage your condition and maintain your quality of life. Take all your medication as prescribed, especially diuretics. Diuretics can be a nuisance because they cause you to urinate more often, but remember that the fluid is better out than in.^[16]

Keep tabs on weight changes. Weigh yourself at the same time every morning after you go to the bathroom and before you eat breakfast, then write it down. If you notice a weight gain of 2-3 pounds overnight or 5 pounds in a week, call your doctor or advanced care provider. He or she may want to adjust the dosage of your water pill.^[16]

Be active and try to keep up your physical activity. Your doctors do not want you to lose muscle mass and become weak. Listen to your body. Even mild to moderate exercise such as walking, biking, and swimming can help. A routine exercise program will also help you notice a change in symptoms such as feeling short of breath sooner than if you were inactive.^[16]

Watch your salt intake. Because of your mitral valve disease, you are prone to retain too much fluid. Salt, or sodium, acts like a sponge, and water is trapped inside your body. While it’s a good idea to avoid the salt shaker, processed and restaurant foods are the main source of sodium in our diets.^[16]

Eat a healthy diet high in fruits and vegetables and low in saturated fats. Keep your blood pressure under good control. If you have had a heart valve replaced, your provider may have you take antibiotics before a dental procedure to prevent a heart valve infection.^[16]

See your cardiology team if your symptoms change. Talk with your cardiologist about treatment options that are best for you. Regular checkups are important to monitor the progression of your condition.^[16]