Mitral Valve Incompetence

Mitral valve incompetence is a condition where the valve between the two left chambers of your heart doesn’t close properly, allowing blood to leak backward. This common heart valve problem can range from mild, causing no symptoms, to severe, requiring treatment to prevent serious complications.

Mitral regurgitation, Mitral insufficiency, Mitral valve regurgitation, Leaky mitral valve

Table of contents

• What is mitral valve incompetence?
• Types of mitral valve incompetence
• What causes this condition?
• Signs and symptoms
• How is it diagnosed?
• Treatment options
• Living with mitral valve incompetence

What is mitral valve incompetence?

Mitral valve incompetence is the most common type of heart valve disease^[1]. In this condition, the mitral valve, which is located between the left upper chamber (left atrium) and left lower chamber (left ventricle) of your heart, does not close properly^[4]. When your heart beats, this valve normally opens to let blood flow from the upper chamber to the lower chamber, then closes tightly to prevent blood from flowing backward^[5].

When the mitral valve doesn’t close all the way, some blood leaks backward into the left atrium instead of flowing forward to the rest of your body^[3]. This backward flow of blood is what doctors call regurgitation or incompetence. If the leakage is severe, your heart has to work harder to pump enough blood forward, which can strain the heart over time^[6].

Many people with mild mitral valve incompetence have no symptoms and may not even know they have the condition. The heart can easily compensate for small leaks, and you may feel perfectly fine^[4]. However, if too much blood keeps leaking backward, your heart will have to work harder, which can eventually take a toll and lead to symptoms and complications^[4].

• Heart
• Mitral valve
• Left atrium
• Left ventricle

Types of mitral valve incompetence

Mitral valve incompetence can be divided into different types based on what causes the problem and how quickly it develops^[4].

Primary mitral regurgitation occurs when the problem is with the valve itself. Structural damage to one or more parts of the valve prevents it from closing normally^[4]. For example, the valve flaps may become too stretchy to form a tight seal, or they may become too stiff to close properly^[4].

Secondary mitral regurgitation happens when the problem is not the valve itself but rather heart disease that affects the chambers supporting the valve. For example, a condition called cardiomyopathy (a disease of the heart muscle) can cause your heart to grow larger and weaker^[4]. These changes can shift the positioning of the different parts of your valve and prevent its flaps from fully closing^[4].

The condition can also be classified by how quickly it develops. Acute mitral regurgitation develops suddenly and severely, often due to a heart attack or infection^[3]. Chronic mitral regurgitation develops gradually over time^[3]. Most people with mitral valve incompetence have the chronic form, which progresses slowly over many years.

What causes this condition?

The most frequent cause of mitral valve incompetence in developed countries is degenerative disease, which includes conditions like mitral valve prolapse and myxomatous degeneration (a weakening of the valve tissue)^[2][3]. In mitral valve prolapse, the valve flaps bow or bulge back into the left atrium because they are too stretchy^[20]. This is the most common heart valve condition, affecting about 2% to 3% of the population^[20].

In developing countries, rheumatic heart disease remains the most common cause of mitral valve problems^[3]. This condition results from untreated strep throat that leads to scarring and damage to the heart valves^[6].

Other common causes of mitral valve incompetence include^[2][3]:

• Damage from a heart attack, which can injure the muscles around the valve or cause the cords that attach to the valve to rupture
• Infective endocarditis (infection of the heart valves), which can destroy part of the valve or cause it to perforate
• Coronary artery disease and high blood pressure
• Certain medications, particularly some diet pills that were removed from the market in 1997
• Connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome
• Natural aging, as valves can deteriorate over time

Some people are born with mitral valve problems, which is called congenital mitral valve disease^[10]. In some families, valve disease may run in the family due to genetic factors^[3].

Signs and symptoms

Mitral valve incompetence is often mild and develops slowly over time. Many people do not have any symptoms for many years^[1]. You may not feel anything unusual if the leak in your valve is small. However, when the condition becomes more severe or develops quickly, symptoms can appear^[1].

The most common symptom is shortness of breath, which doctors call dyspnea^[4]. You may feel like you can’t get enough air into your lungs, or that you have to work harder to breathe. This can happen when you’re resting, lying down, trying to sleep, or being physically active^[4].

Other symptoms of mitral valve incompetence include^[1][4]:

• Feeling extremely tired or exhausted (fatigue)
• An irregular heartbeat or feeling like your heart is flip-flopping or skipping a beat (heart palpitations)
• Chest pain
• Coughing
• Swelling (edema) in your legs or feet
• Feeling lightheaded or like you may faint

When symptoms develop suddenly, this is called acute mitral valve regurgitation and requires immediate medical attention^[3]. This can happen after a heart attack or when a valve infection destroys part of the valve^[6].

During a physical examination, your healthcare provider may hear a whooshing sound called a heart murmur when listening to your heart with a stethoscope^[10]. This murmur is the sound of blood leaking backward through the valve^[10].

How is it diagnosed?

To diagnose mitral valve incompetence, your healthcare provider will perform a physical exam and ask questions about your symptoms and medical history^[10]. They will listen to your heart and lungs using a stethoscope. If you have mitral valve incompetence, they may hear a heart murmur^[10].

Several tests can confirm the diagnosis and determine how severe the condition is:

Echocardiogram is the main test used to diagnose mitral valve incompetence^[10]. This test uses sound waves to create moving pictures of your beating heart. It shows the structure of the mitral valve and how blood flows through your heart^[10]. A standard echocardiogram is called a transthoracic echocardiogram (TTE) and is done by placing a device on your chest^[10]. Sometimes, a more detailed test called a transesophageal echocardiogram (TEE) is needed, which creates pictures from inside your body^[10].

An electrocardiogram (ECG or EKG) shows how your heart is beating^[10]. Sticky patches called sensors are attached to your chest and sometimes your arms and legs. These are connected by wires to a computer that displays the results. This test can show irregular heart rhythms related to mitral valve disease^[10].

A chest X-ray can show whether your heart is enlarged, which can be a sign of heart valve disease^[10]. Other tests that may be ordered include cardiac MRI (magnetic resonance imaging), cardiac catheterization, or exercise stress tests to see how your heart responds to physical activity^[10][12].

Treatment options

Treatment for mitral valve incompetence depends on how severe your condition is, whether you have symptoms, and whether the condition is getting worse^[1]. If the leakage is mild, you may not need any treatment right away^[1]. Your healthcare provider will monitor your condition with regular checkups^[1].

Medications

Medicines cannot fix a leaky valve, but they can help manage symptoms and prevent complications^[6]. Your healthcare provider may prescribe medications such as:

• Diuretics (water pills) to remove excess fluid from your lungs and reduce swelling in your legs^[6]
• Blood pressure medications such as ACE inhibitors, beta-blockers, or calcium channel blockers to reduce the strain on your heart^[6]
• Blood thinners to help prevent blood clots if you have an irregular heartbeat^[6]
• Medicines to control abnormal heart rhythms^[6]

Surgical and catheter procedures

Severe mitral valve incompetence often requires a procedure or surgery to repair or replace the valve^[1]. Mitral valve repair is generally preferred over valve replacement when possible, as it gives better long-term results^[15].

In valve repair surgery, the surgeon fixes the damaged valve without removing it. This may involve trimming or reshaping the valve flaps, tightening or replacing the ring around the valve, or shortening loose cords that anchor the valve^[24]. Valve repair can often be done using minimally invasive techniques through small incisions, which means less pain and faster recovery compared to traditional open-heart surgery^[5].

A newer option is a transcatheter procedure that can be done without open-heart surgery. In this procedure, called transcatheter edge-to-edge repair (TEER) or MitraClip therapy, a small clip is attached to your valve leaflets through a catheter inserted into a vein in your leg^[15]. This helps the valve close more completely. This procedure may be an option for people who are at high risk for surgery^[15].

If the valve is too damaged to repair, valve replacement may be necessary. The damaged valve is removed and replaced with either a mechanical valve (made from metal and plastic) or a biological valve (made from animal tissue)^[6].

Living with mitral valve incompetence

If you have mitral valve incompetence, there are several things you can do to manage your condition and prevent complications^[18]:

Take all your medications as prescribed, especially diuretics. While water pills may be inconvenient because they make you urinate more often, they are important for keeping fluid out of your lungs^[18].

Monitor your weight daily. Weigh yourself at the same time every morning after you go to the bathroom and before you eat breakfast, then write it down^[18]. If you notice a weight gain of 2 to 3 pounds overnight or 5 pounds in a week, call your healthcare provider, as this may mean fluid is building up^[18].

Stay physically active. Even mild to moderate exercise such as walking, biking, and swimming can help^[18]. Listen to your body and don’t be afraid to exercise unless your doctor tells you otherwise. Regular exercise will also help you notice changes in symptoms sooner^[18].

Watch your salt intake. Because of your leaky valve, you are more likely to retain too much fluid. Salt acts like a sponge, trapping water inside your body^[18]. Avoid adding salt to your food and be aware that processed and restaurant foods are the main sources of sodium in most diets^[18].

Eat a heart-healthy diet high in fruits and vegetables and low in saturated fats^[18]. This can help prevent other heart problems that can make mitral valve incompetence worse.

Keep your blood pressure under control. This is especially important to slow the progression of mild or moderate mitral regurgitation^[18].

Watch for changes in your symptoms. Call your healthcare provider if you notice increasing shortness of breath, swelling in your legs, difficulty breathing at night, or feeling more tired than usual^[21]. These could be signs that fluid is building up in your lungs, which doctors call congestive heart failure^[21].

Attend regular follow-up appointments. Your healthcare provider needs to monitor your condition over time. If you have very severe mitral valve incompetence, you may need an echocardiogram every year. Those with less severe disease may need one every 3 to 5 years^[12].

Without proper treatment, severe mitral valve incompetence can lead to serious complications including heart rhythm problems called arrhythmias, particularly atrial fibrillation, and heart failure^[1]. However, with appropriate monitoring and treatment, many people with this condition can maintain a good quality of life.