Overview
Diagnosis
To diagnose mitral valve regurgitation, a health care professional performs a physical exam and reviews your symptoms and medical history. A stethoscope is used to listen to the heart and lungs. A whooshing sound called a heart murmur may be heard when blood leaks backward through the mitral valve. Additional tests may be done to confirm the diagnosis or rule out other conditions with similar symptoms.
Common tests to diagnose mitral valve regurgitation include:
Echocardiogram. This test uses sound waves to create images of the beating heart. It shows the structure of the mitral valve and how blood flows through the heart. A transthoracic echocardiogram (TTE) can confirm mitral valve regurgitation and determine its severity. A transesophageal echocardiogram (TEE) provides more-detailed images from inside the body when needed.
Electrocardiogram (ECG). Sensors placed on the chest, arms and legs measure the heart’s electrical activity. An ECG can detect irregular heart rhythms connected to mitral valve disease.
Chest X-ray. A chest X-ray shows the condition of the heart and lungs and can help identify an enlarged heart or fluid buildup.
Cardiac MRI. Magnetic fields and radio waves create detailed images of the heart. This test helps show the severity of regurgitation and provides information about the lower left heart chamber.
Exercise or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. They show how the heart responds to physical activity and whether symptoms occur during exercise. Medicines may be used if exercise is not possible.
Cardiac catheterization. This test may be used when other tests do not provide clear results. A thin tube is guided through a blood vessel to the heart, and dye is injected to make the heart chambers and arteries more visible on X-ray.
Staging
After diagnosis, your care team may determine the stage of heart valve disease. Staging helps guide the most appropriate treatment. It is based on symptoms, severity, valve structure and blood flow through the heart and lungs.
Heart valve disease is staged into four groups:
• Stage A: At risk due to factors that may lead to valve disease
• Stage B: Progressive disease that is mild or moderate, with no symptoms
• Stage C: Asymptomatic severe disease
• Stage D: Symptomatic severe disease
Outlook
A person’s outlook after being diagnosed with mitral valve regurgitation varies. The prognosis depends on several factors:
• The underlying cause of the valve disease
• The stage of heart valve disease
• How severe the regurgitation is
• How long the condition has been present
Treatment
The goals of treatment are to help the heart work more effectively, reduce symptoms and prevent complications. Some people, particularly those with mild regurgitation, may not need treatment right away. Your health care team considers your symptoms and stage when planning care. Treatment may include:
• Healthy lifestyle changes
• Regular health checkups
• Medicines to manage symptoms and prevent complications
• Surgery to repair or replace the mitral valve
A cardiologist typically manages care for mitral valve regurgitation. Treatment at a medical center experienced in heart valve disease may provide the best outcomes.
Medications
Medicines may be used to reduce symptoms and prevent complications. These can include:
• Diuretics to reduce or prevent fluid buildup
• Blood thinners to prevent clots if atrial fibrillation is present
• Blood pressure medicines to manage high blood pressure, which worsens regurgitation
Surgery or other procedures
A damaged mitral valve may need repair or replacement, even without symptoms. Mitral valve repair is preferred when possible, as it preserves the natural valve and may protect heart function. Some procedures may be done at the same time as surgery for another heart condition. In some centers, robot-assisted minimally invasive surgery is an option.
During mitral valve repair, the surgeon may:
• Patch holes
• Reconnect valve flaps
• Remove excess tissue to ensure proper closure
• Replace supporting cords
• Separate valve leaflets that have connected
Additional procedures include:
• Annuloplasty to tighten or reinforce the ring around the valve
• Valvuloplasty to widen a narrowed valve opening using a balloon catheter
• Mitral valve clip placement to reduce regurgitation for those not suited for surgery
During mitral valve replacement, the damaged valve is removed and replaced with either a mechanical valve or a biological tissue valve made from cow, pig or human heart tissue. A valve-in-valve catheter procedure may be used if a biological valve wears out. Mechanical valves require lifelong blood thinners, while biological valves eventually need replacement.
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