The mitral valve separates the left top chamber (atrium) and the left bottom chamber (ventricle) of the heart. It has two very thin flaps called leaflets. Normally, when the leaflets open, blood pumps through. When the leaflets close, they prevent blood from flowing backward.

If your mitral valve does not work correctly, you may have mitral regurgitation, also called mitral valve insufficiency. This means that the valve does not close tightly, and some blood flows backward from the left ventricle to the left atrium. When this happens, your heart must work harder to pump that extra blood.

You may not even notice your heart has a small leak, but it can get worse over time. This is known as chronic mitral regurgitation. Larger leaks can cause the heart to weaken, and people usually begin to notice symptoms such as:

• Being short of breath
• Feeling fatigued or tired when doing their usual activities
• Holding on to fluid in their ankles and feet

The leaking can also occur suddenly (for example after a heart attack). This is called acute mitral regurgitation and is an emergency.

Your health care provider may be able to discover the regurgitation by listening to your chest with a stethoscope and hearing a sound called a murmur, which should prompt further testing.

There are two types of mitral regurgitation (MR):

• Primary MR (degenerative) is caused by a problem with the mitral valve itself.
• Secondary MR (functional) is caused by a problem with the left bottom chamber, or ventricle, of the heart.

Common causes of mitral regurgitation include:

Mitral valve prolapse: The valve’s tissue flaps or the tendon cords that anchor the valves are weakened and stretch. The flaps then bulge into the top chamber, or atrium, with each heartbeat.

Rheumatic fever: This can be a complication of untreated strep throat. It can damage the valve in childhood and lead to MR in adults. This most commonly occurs in underdeveloped countries.

Heart attack: A heart attack can cause decreased blood flow to the area of the heart that supports the mitral valve, making it weak. The change can be quite severe and sudden if the tendon cords are ruptured because of the heart attack.

Weakened heart (or cardiomyopathy): Sometimes, the bottom chamber (ventricle) of the heart stretches. When this happens, the mitral valve also is stretched and becomes leaky.

Endocarditis: This bacterial infection can attach to the heart valves and damage the valve itself.

Trauma: For example, trauma to the chest in a car accident.

Congenital heart defects: Some people are born with either leaky heart valves or enlarged hearts that make it hard for the valves to close.

Drugs: The medications ergotamine and bromocriptine have been linked with mitral regurgitation. Weight loss medication, such as fenfluramine (fen-phen), has also been associated with this valve problem. This medication has been taken off the market. If you have taken these medications in the past, talk to your provider about getting your heart valves checked. Radiation exposure during cancer treatment also could contribute to the valve changing shape.

Age: Over time, your body can deposit calcium around the valves and make it hard for your valves to close tightly.

People often can have mild or moderate mitral regurgitation without any signs or symptoms. As the condition worsens, people can develop:

• Heart murmur
• Shortness of breath—especially when lying down
• Fatigue
• Swollen feet or ankles
• Heart palpitations
• Chest pain

Please call your provider if you have any of these symptoms.

Teamwork among patients, providers, valve teams, and nurses can help manage your valve condition.

During a routine physical exam, your health care provider will listen to your heart with a stethoscope. If your provider hears a heart murmur, he or she may suspect you have mitral regurgitation.

Other tests will be ordered to confirm the diagnosis and to determine the type of damage or issue with your heart valve. Those tests can include the following:

• An echocardiogram (heart ultrasound) of your heart helps assess the severity of how leaky the valve is. It also helps categorize your condition as primary or secondary MR.
• A transesophageal echocardiogram (TEE) is a special type of ultrasound that looks at the mitral valve from a different angle. In this test, a camera is passed down the esophagus through the throat (using moderate sedation) to get a closer look at your heart valves.
• A stress test may also be ordered to help evaluate any symptoms you might have during exercise.
• A cardiac MRI is a specialized test that looks at the mitral valve in another way to help measure the severity of mitral regurgitation. It can be used if the echocardiogram or stress tests don’t provide enough information.
• A cardiac catheterization (heart catheterization or coronary angiogram) may be performed if the results of other less invasive tests are not consistent with symptoms. A small plastic tube is inserted into an artery in your wrist or groin and pushed all the way up toward the heart. The test can measure the pressures around the valves. Sometimes, the test involves using dye to show where the blood flows once it gets to the heart. This test also can reveal blockages in your heart arteries that could contribute to your symptoms.

There are several treatment options for MR depending on the type and severity of regurgitation.

Your health care provider will follow your condition with routine echocardiograms (ultrasounds of the heart) to see how badly the valve is leaking and whether it is worsening over time. According to the ultrasound, your MR may be mild, moderate, or severe.

Your doctor will likely order tests to monitor your condition and decide if you need or are ready to have your valve repaired or replaced. You will work together with your care team to decide which option is best and safest for you. If your MR is considered severe, your provider may refer you to see a heart surgeon, an interventional cardiologist, and other specialists on a valve team.

Treatment options for MR include medical therapy, and repair or replacement.

Medical Therapy

Treatment with medications and lifestyle changes (such as limiting fluid intake and monitoring weight) to control the symptoms related to MR.

Medical therapy does not address the leaky valve itself, but this may be the best option for patients who have no symptoms in the “watchful waiting” phase of their disease, or for those who do not wish to or cannot undergo surgery.

Repair or Replacement

A cardiac surgeon may recommend open-heart surgery to either repair or replace the mitral valve.

Some minimally invasive surgical techniques, done through small incisions in the chest, can repair or replace the mitral valve. Robot-assisted heart surgery is also an option for some patients.

In patients who are deemed high-risk for open-heart surgery, a mitral valve “clip” can be delivered via a catheter-based technique to decrease valve regurgitation. Certain clinical trials offered at specialized centers across the country also offer catheter-based mitral valve replacement, although this technique remains investigational.

If you have surgery or other interventional procedure, your valve team will talk to you about recovery time, the need for blood thinners and any physical limits you should know about.

It is important to remember that you and your family are a part of the decision-making process, and the more questions you ask, the better!

For suggestions about what to ask your care team, go to Questions to Ask Your Doctor.

If you’ve been diagnosed with mitral valve regurgitation, there are several key questions that you should ask your cardiologist during your next visit. These questions will ensure that you and your doctor have discussed your major risk factors so that you can become or stay as healthy as possible.

• What is mitral valve regurgitation?
• How do I know if I have mitral valve regurgitation? Are there symptoms I should watch for?
• How common is mitral valve regurgitation?
• Is mitral valve regurgitation associated with other diseases?
• Does mitral valve regurgitation require treatment? If so, when?
• What are the treatment options for mitral valve regurgitation?
• Does mitral valve regurgitation make having other valve defects more likely?
• How often should I follow up with my cardiologist or primary care physician for mitral valve regurgitation?
• How is mitral valve regurgitation monitored over time?
• What is the risk of mitral valve regurgitation if it is not corrected?