Mitral valve disease is the medical condition in which the mitral valve, located between the heart’s left atrium and left ventricle, doesn’t work properly. Mitral valve disease includes:

• Mitral valve regurgitation, a condition in which the flaps, or leaflets, of the mitral valve don’t close tightly, allowing blood to flow backward into the left atrium. The most common cause of this blood leakage is mitral valve prolapse, in which the leaflets bulge back into the left atrium when the heart contracts.
• Mitral valve stenosis, a condition in which the mitral valve leaflets become thick, stiff or fused, resulting in a narrowed valve opening and reduced blood flow between the left atrium and left ventricle.

Baptist Health is known for advanced, superior care for patients with heart problems and the diagnosis, management and treatment of mitral valve disease. You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. Here, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Mitral Valve Stenosis and Regurgitation Signs and Symptoms

Symptoms of mitral valve regurgitation are not always present, but when they are they include: 

• Fatigue, especially during increased activity
• Heart murmur an irregular sound heard when blood flows turbulently through the heart
• Heart palpitations, rapid or fluttering heartbeats
• Shortness of breath with exertion or when lying flat
• Swollen feet or ankles

Mitral valve stenosis symptoms may be absent or mild. More serious symptoms include:

• Chest discomfort or pain
• Dizziness or fainting
• Fatigue, especially during increased activity
• Heart palpitations rapid or fluttering heartbeats
• Heavy coughing, sometimes with bloody sputum
• Severe headache, trouble speaking, or other stroke symptoms
• Shortness of breath with exertion or when lying flat
• Swollen feet or legs

Diagnosis

To determine if a patient has mitral valve regurgitation, the physician will ask questions about family history and symptoms and listen to the patient’s heart with a stethoscope. Additional diagnostic tests and procedures may include:

Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray movie is taken to show how the aortic valve functions and measure pressure in the heart chambers.

Cardiac MRI: A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Chest X-ray: A common imaging test of the heart and aorta, which can identify enlargement of the left atrium or ventricle.

CT angiogram: A thin tube (catheter) is inserted into a blood vessel and dye injected to make the blood vessel visible during an X-ray. This can show blood vessel abnormalities.

Echocardiogram: This ultrasound exam uses sound waves to take moving pictures of the heart’s chambers and valves. It can identify abnormalities in the structure or function of the mitral valve.

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged or overworked. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Stress test: This test is conducted during exercise. If a patient can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise is used to make the heart work hard and beat fast while heart tests are administered.

To determine if a patient has mitral valve stenosis, the physician will ask questions about family history and symptoms and listen to the patient’s heart with a stethoscope. The physician will also listen for a buildup of fluid in the lungs. Additional diagnostic tests and procedures may include those done for mitral valve regurgitation, as well as:

Transesophageal Echocardiogram: A small transducer attached to the end of a tube inserted down the esophagus allows a closer look at the mitral valve than a regular echocardiogram does.

Transthoracic Echocardiogram: Sound waves directed at the heart from a wand-like device (transducer) held on the chest produce video images of the heart in motion.

Mitral Valve Disease Causes

Mitral valve disease causes vary based on the type of mitral valve disease. Mitral valve regurgitation causes include factors that can lead to heart disease, such as:

• High blood pressure
• High cholesterol
• Obesity
• Physical inactivity
• Smoking

Mitral valve stenosis is not usually caused by behaviors or lifestyle factors.

Risk Factors

Risk factors that could contribute to mitral valve regurgitation include:

Age: By middle age, many people have some mitral valve regurgitation caused by natural deterioration of the valve.

Cardiomyopathy: Certain conditions can cause the heart to work harder, gradually enlarging the left ventricle. This can stretch the tissue around the mitral valve, which can lead to leakage.

Certain medications: Prolonged use of certain medications, like some used to treat migraines and other conditions, can cause mitral valve regurgitation.

Congenital heart defects: Some people are born with damaged heart valves.

Damaged tissue cords: Over time, tissue cords that anchor the flaps of the mitral valve to the heart wall may stretch or tear, especially in people with mitral valve prolapse. A tear can cause sudden leakage through the mitral and may require repair by heart surgery. Chest trauma can also rupture the cords.

Endocarditis: This infection of the heart’s inner lining typically occurs when bacteria from the mouth or elsewhere get into the bloodstream and lodge in the heart.

Mitral valve prolapse: In this condition, the leaflets and tendon-like cords supporting the mitral valve weaken and stretch so that when the left ventricle contracts, the valve leaflets bulge into the left atrium. This common defect can prevent the mitral valve from closing and lead to regurgitation.

Previous heart attack: A heart attack can damage the mitral valve and affect its function.

Radiation therapy: In rare cases, radiation treatments for cancer focused on the chest can lead to this condition.

Rheumatic fever: Rare in the United States and other developed countries, this illness can occur without prompt or complete treatment of a strep throat infection damaging the heart valves.

Trauma: Severe trauma, like from a car accident, can lead to mitral valve regurgitation.

Risk factors that could contribute to mitral valve stenosis include:

Autoimmune diseases: Rarely, conditions such as lupus can lead to mitral valve stenosis.

Calcium deposits: As a person ages, calcium deposits can build up around the ring around the mitral valve, which can occasionally cause mitral valve stenosis.

Congenital heart defects: Some babies are born with narrowed mitral valves.

Radiation therapy: In rare cases, radiation treatments for cancer –focused on the chest – can lead to this condition.

Rheumatic fever: Rare in the United States and other developed countries, this illness can occur without prompt or complete treatment of a strep throat infection – damaging the heart valves.

Prevention

While many risk factors cannot be controlled, you can help prevent cases of mitral valve regurgitation caused by heart disease.

Get enough exercise: Even moderate activity can make a big difference in heart health and help you maintain a healthy weight.

Stop smoking: Smoking can lead to high blood pressure and otherwise damage the heart.

Take medications as prescribed: If you’re on medications to lower cholesterol or blood pressure, continue taking them as directed.

Watch what you eat: Stick to a diet rich in fruit, vegetables and whole grains and low in fat, sugar and salt.

Risk factors for mitral valve stenosis cannot be prevented.

Prognosis

Prognosis for mitral valve regurgitation varies based on its severity. Medication can ease symptoms, but not reverse damage to a valve. Surgical treatments have greatly improved the prognosis for mitral valve regurgitation patients.

Prognosis for mitral valve stenosis varies due to the severity of narrowing and presence of symptoms.

Treatment and Recovery

Treatment for mitral valve regurgitation depends on the severity of the condition, and may include:

Medication

Medication can’t correct valve damage or defects, but some can help the symptoms, such as:

• Angiotensin-converting enzyme (ACE) inhibitors, which lower blood pressure
• Anticoagulants, which prevent blood clots from forming and causing a heart attack or stroke
• Beta blockers, which lower the heart rate and blood pressure
• Diuretics, which remove excess fluid from the body

Minimally Invasive Procedures

Mitral valve replacement or repair usually requires open-heart surgery. Less invasive surgical techniques and procedures are being explored for mitral valve treatment, including:

• Catheter procedures: In one procedure, the surgeon uses a catheter to implant a clip or plugging device into the mitral valve. To replace a previously inserted bioprosthetic valve, the surgeon inserts a catheter with a balloon at the end into a blood vessel in the leg and threads it into the heart. A replacement valve is then inserted into the catheter and guided to the heart. The surgeon inflates the balloon in the bioprosthetic valve and places the replacement valve inside.
• Mini-sternotomy: The surgeon makes a small incision in the breastbone and accesses the heart to replace the mitral valve.
• Robot-assisted heart surgery: The surgeon uses robotic arms to duplicate specific maneuvers used in open-heart surgeries to conduct mitral valve repair.
• Thoracoscopic surgery: The surgeon inserts a long, thin tube containing a tiny, high-definition video camera into a small incision in the chest and conducts the procedure using long instruments inserted through small incisions between the ribs.

Surgery

Your physician may recommend surgery to treat mitral valve regurgitation. Options include:

• Valve repair: A surgeon repairs the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. He or she may also tighten or reinforce the ring around the valve (annulus).
• Mitral valve replacement: If your mitral valve can't be repaired, your surgeon may replace it with a mechanical or biological valve. Mechanical valves, made from metal, are durable but carry a risk of blood clots. Biological tissue valves — which may come from a pig, cow or human deceased donor — eventually need to be replaced.

Recovery after valve surgery can take a long time. Your activities will be limited, you will experience physical and emotional changes, and you may have problems such as chest pain or trouble sleeping.

Watchful Waiting

Some people with mild mitral valve regurgitation may not need treatment and should just be regularly monitored by a physician.

Treatment for mitral valve stenosis depends on the severity of the condition, and may include:

Medication

Medication can’t correct valve damage or defects, but some can help the symptoms, such as:

· Antiarrhythmics, which treat atrial fibrillation or other rhythm disturbances associated with mitral valve stenosis

· Antibiotics, which prevent recurrence of rheumatic fever

· Anticoagulants, which prevent blood clots from forming and causing a heart attack or stroke

· Beta blockers, which lower the heart rate and blood pressure

· Diuretics, which remove excess fluid from the body

Repair with Balloon Valvuloplasty

In this nonsurgical procedure, the surgeon guides a soft, thin tube (catheter) tipped with a balloon through a blood vessel in your arm or groin to the narrowed valve. Once in position, the balloon is inflated to widen the valve, improving blood flow.

Surgery

Surgical options for mitral valve stenosis include:

• Commissurotomy: If balloon valvuloplasty isn't an option, your surgeon might perform open-heart surgery to remove calcium deposits and scar tissue to clear the valve’s opening. Open commissurotomy requires that you be put on a heart-lung bypass machine during the surgery. Recovery after surgery can take a long time. Your activities will be limited, you will experience physical and emotional changes, and you may have problems such as chest pain or trouble sleeping.
• Valve replacement: If your mitral valve can't be repaired, your surgeon may replace it with a mechanical or biological valve. Mechanical valves, made from metal, are durable but carry a risk of blood clots. Biological tissue valves — which may come from a pig, cow or human deceased donor — eventually need to be replaced.

Complications

Mild mitral valve regurgitation may not cause problems, but a severe case can lead to complications like:

Atrial fibrillation: This heart rhythm irregularity, in which the upper chambers of the heart beat chaotically and rapidly, can cause blood clots, which can break loose from your heart and travel to other parts of your body. This can lead to a stroke if it cuts off blood supply to the brain.

Heart failure: This occurs when the heart can't pump enough blood to meet the body's needs

Pulmonary hypertension: This type of high blood pressure affects the vessels in the lungs, leading to shortness of breath, dizziness, fainting, leg swelling and other symptoms.

Mitral valve stenosis can strain the heart and decrease blood flow, leading to complications like:

Atrial fibrillation: This heart rhythm irregularity, in which the upper chambers of the heart beat chaotically and rapidly, can cause blood clots, which can break loose from your heart and travel to other parts of your body. This can lead to a stroke if it cuts off blood supply to the brain.

Heart enlargement: The pressure buildup of mitral valve stenosis results in enlargement of the heart’s left atrium.

Heart failure: This occurs when the heart can't pump enough blood to meet the body's needs

Lung congestion (pulmonary edema): Blood and fluid can back up into the lungs, leading to shortness of breath and, sometimes, coughing of blood-tinged sputum.

Pulmonary hypertension: This type of high blood pressure affects the vessels in the lungs, leading to shortness of breath, dizziness, fainting, leg swelling and other symptoms.