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Nov 28, 2023

Mitral valve regurgitation

To diagnose mitral valve regurgitation, a health care provider will usually do a

To diagnose mitral valve regurgitation, a health care provider will usually do a physical exam and ask questions about your symptoms and medical history, including whether you have mitral valve prolapse. The provider will typically listen to your heart with a stethoscope. A heart murmur, also called a holosystolic murmur, may be heard. The mitral valve heart murmur is the sound of blood leaking backward through the valve.

Tests may be done to confirm a diagnosis of mitral valve regurgitation or to check for other conditions that can cause similar signs and symptoms.

A health care provider performs an echocardiogram at Mayo Clinic.

Common tests to diagnose mitral valve regurgitation include:

Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the structure of the mitral valve and blood flow in the heart. A standard echocardiogram, also called a transthoracic echocardiogram (TTE), can confirm a diagnosis of mitral valve regurgitation and determine its severity. Echocardiography can also help in the diagnosis of congenital mitral valve disease, rheumatic mitral valve disease and other heart valve conditions.

Sometimes, a transesophageal echocardiogram (TTE) may be done to get a closer look at the mitral valve. In this type of echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from the mouth to the stomach (esophagus).

After testing confirms a diagnosis of mitral or other heart valve disease, your health care provider may tell you the stage of disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.

Heart valve disease is staged into four basic groups:

How well a person does after being diagnosed with mitral valve regurgitation varies. The outlook (prognosis) for mitral valve regurgitation depends on:

About one in 10 people with chronic mitral valve regurgitation due to prolapse needs surgery to repair or replace the valve.

Our caring team of Mayo Clinic experts can help you with your mitral valve regurgitation-related health concerns Start Here

The goals of mitral valve regurgitation treatment are to improve heart function while reducing signs and symptoms and avoiding future complications. Some people, especially those with mild regurgitation, might not need treatment. Your health care provider will consider your symptoms and stage of regurgitation, among other things, when discussing treatment options with you.

Treatment of mitral valve regurgitation may include:

A doctor trained in heart disease (cardiologist) typically provides care for people with mitral valve regurgitation. If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of health care providers trained and experienced in evaluating and treating heart valve disease.

Medications may be needed to reduce mitral valve regurgitation symptoms and to prevent complications of heart valve disease.

Types of medications that may be prescribed for mitral valve regurgitation include:

A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don't have symptoms. Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement. Your health care provider can discuss the risks and benefits of each type of heart valve with you to determine which valve may be best for you.

If you need surgery for another heart condition, a surgeon might perform mitral valve repair or replacement at the same time as that other surgery.

Mitral valve surgery is usually done through a cut (incision) in the chest. Surgeons at some medical centers sometimes use robot-assisted heart surgery, a minimally invasive procedure in which robotic arms are used to do the surgery.

In robot-assisted mitral valve repair surgery at Mayo Clinic, two board-certified cardiac surgeons use robotic equipment to perform the exact same procedure conducted in traditional open chest heart surgery, without needing to make a large incision through your breast bone. Your surgeons perform the procedure through small incisions in your right chest, using finger-sized instruments that are slipped in between your ribs. In this procedure, one surgeon sits at a remote console and views your heart using a magnified high-definition 3D view on a video monitor. Another surgeon works at the operating table and ensures the safe movement of the robotic arms. You'll need to be supported by a heart-lung bypass machine during the procedure. This will allow your surgeons to stop your heart briefly and insert instruments into the inner chambers to repair the mitral valve. Your surgeon uses robotic arms to duplicate specific maneuvers used in open-chest surgeries. The procedure is performed through small openings in your chest, through which will be inserted micro instruments and a thin high-definition camera tube or thoracoscope. One opening will be a mini working port through which surgeons will insert materials used during the procedure. Your surgeon performs the procedure from the remote console. Your surgeon's hand movements are translated precisely to the robotic arms at the operating table, which move like a human wrist. At the operating table, another surgeon works together with the surgeon at the console to perform the procedure and ensure it is conducted safely and efficiently. Your surgeon at the console can closely examine the complicated mitral valve problem using the high-definition 3D video monitor. This allows your surgeon to have a clearer, more lifelike perspective of your heart than is possible during open heart surgery, in which surgeons view the heart from a further distance.

To repair the mitral valve, your surgeon makes an incision in the left upper chamber or left atrium of your heart to access the mitral valve. Your surgeon can then identify the problem with your mitral valve and repair the valve itself. In mitral valve prolapse, the mitral valve, located between your heart's left atrium and the left lower chamber or left ventricle, doesn't close properly. The leaflets of the valve bulge or prolapse upward or back into the left atrium as your heart contracts. This leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation. To repair this condition, various complicated technical procedures are performed. Sometimes a small section of the leaflet, the part of the valve that doesn't close properly, is identified, and a triangular section is removed, as shown. Your surgeon then stitches the cut edges of the leaflet together to repair the valve.

In other cases, new chords or chordae supporting the broken leaflet are inserted. An annuloplasty band is then placed around the circumference of the valve to stabilize the repair. Your surgeon will close the incisions in your chest after the procedure. Mayo's staff will assist you during your recovery over a three-day period in the hospital. In robot-assisted heart surgery, most people have a quicker recovery, smaller incisions, and less pain than following open-chest surgery. Studies have also found that this procedure performed at Mayo Clinic is cost effective, with similar or lower total costs compared with traditional open-chest surgery.

In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).

In mitral valve repair, a surgeon removes the part of the mitral valve that doesn't close properly, as shown in the top image. Then the surgeon sutures together the edges and cinches the circumference of the valve with an annuloplasty band to support the valve, as shown in the bottom image.

Mitral valve repair saves the existing valve and may preserve heart function. Whenever possible, mitral valve repair is recommended before considering valve replacement. People who have mitral valve repair for mitral regurgitation at an experienced medical center generally have good outcomes.

During mitral valve repair surgery, the surgeon might:

Other mitral valve repair procedures include:

If a previously replaced mitral valve has a leak surrounding the artificial valve, a cardiologist may insert a device to stop the leak.

During mitral valve replacement, the surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Sometimes, a heart catheter procedure is done to place a replacement valve into a biological tissue valve that no longer works well. This is called a valve-in-valve procedure.

If you had mitral valve replacement with a mechanical valve, you'll need to take blood thinners for life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.

The blue purple splashing you see here is the problem, a backwards flow of blood from a leaky mitral valve. And the little white device can be a solution.

The mitral valve is named the mitral valve because it looks kind of like the pope's miter, that hat with two leaflets.

Mayo Clinic cardiologist, Dr. Peter Pollak, says this metal clip is a new option for fixing a leaflet that leaks or is torn.

What we can do with this technology is staple, or clip, those two leaflets together and reduce, or eliminate, the amount of leak that's going backwards.

Smaller than a dime, and implanted using a catheter tube, the clip is intended for patients who are too old or too sick for traditional surgery.

They just wouldn't recover from the open chest procedure.

But thanks to this closed chest beating heart procedure, now there's another way to mend a mitral valve leak.

It allows them to feel better almost immediately.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Your health care provider may suggest that you make several heart-healthy lifestyle changes. Take these steps:

Women with mitral valve regurgitation should talk to their health care provider before trying to get pregnant. Pregnancy causes the heart to work harder. How a heart with mitral valve regurgitation tolerates this extra work depends on the degree of regurgitation and how well the heart pumps.

If you think you have mitral valve regurgitation, make an appointment to see your health care provider. Here's some information to help you prepare for your appointment.

For mitral valve regurgitation, some basic questions to ask your health care provider include:

Don't hesitate to ask other questions you have.

Your health care provider is likely to ask you a number of questions, including:

Mitral valve regurgitation care at Mayo Clinic

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