Heart disease

Mitral regurgitation

( Updated at 11/05/2023 )

4 minutes of reading

What is mitral regurgitation?

Mitral regurgitation is a disease in which the mitral valve loses its competence and closing function and leaks blood (regurgitation) from the ventricle into the atrium (in the opposite direction to the normal flow of blood).

What is the mitral valve?

The mitral valve is a heart valve that separates the left atrium from the left ventricle. Its function is to allow blood to pass from the left atrium to the left ventricle (opening) and to prevent blood from flowing back from the left ventricle into the left atrium when it is pumped to the rest of the body.

How does mitral regurgitation develop

Mitral regurgitation develops by two main mechanisms:

Problems with the mitral valve itself (primary mitral regurgitation): they can arise from defects in the birth valve, infections that destroy the valve, or even high-impact trauma that can cause a rupture of the valve. They can appear suddenly or get progressively worse over time
Problems of the ventricle that affect the functioning of the mitral valve (secondary mitral regurgitation): usually appear after several years of progression of other heart diseases, such as heart failure, arrhythmias or atrial fibrillation

Are there any risk factors for mitral regurgitation?

The obesity, the arterial hypertension and a sedentary lifestyle due to the changes it causes to the heart and circulatory system can cause mitral regurgitation or aggravate an existing mitral regurgitation.

Is mitral regurgitation common?

yes. Mitral regurgitation is the 2nd leading cause of need for valve surgery in European countries. Currently, with widespread access to antibiotics and the reduction of rheumatic fever, the number of new cases of primary mitral regurgitation has reduced significantly. Secondary mitral regurgitation is now much more common and usually occurs in people over 60 years of age and with other heart diseases.

What are the symptoms of mitral regurgitation?

The main symptoms of mitral regurgitation are:

tiredness
shortness of breath
Low tolerance to physical exercise
Palpitations

How is mitral regurgitation diagnosed?

Mitral regurgitation appears as a diagnostic suspicion after auscultation of a heart murmur. The diagnosis can be confirmed by performing:

a transthoracic echocardiogram, conventional
a transesophageal echocardiogram, an endoscopy-like examination for cardiac evaluation with the aim of identifying in greater detail the functioning of the mitral valve, particularly if you need any intervention for this valve

What are the complications of mitral regurgitation?

Mitral regurgitation may lead to heart failure (causing symptoms of shortness of breath, fatigue with exertion, or swelling of the legs), or also arrhythmias such as atrial fibrillation (which may cause palpitations, chest discomfort or dizziness).

How is mitral regurgitation classified?

Mitral regurgitation is classified by echocardiogram into three grades:

Slight
Moderate
serious

Almost everyone may have a mild or minimal degree of mitral regurgitation that is considered normal (physiological).

Some conditions such as high blood pressure, obesity, sedentary lifestyle as well as aging can aggravate mitral regurgitation to a moderate or severe degree.

When mitral regurgitation reaches a severe degree, intervention may be required.

How is mitral regurgitation treated?

The treatment of mitral regurgitation includes:

lifestyle interventions such as:
- Blood pressure control
- Weight Loss
- Physical exercise
taking medication for symptom relief
Heartbeat control

There is also the possibility of correcting the disease through:

Conventional surgery, performed with an open chest
catheterization, a minimally invasive catheter procedure introduced through a vein in the groin

What is done in mitral valve surgery?

Surgical treatment is the best way to correct valve function and is usually indicated in primary mitral regurgitation. The valve problem can be fixed by:

valve repair (valvuloplasty) while maintaining the valve
replacement with a valve prosthesis
- mechanical, more durable, but which requires chronic medication to thin the blood
- biological, which does not require specific medication for blood fluidization, but which has a shorter durability

What is done in catheterization treatment?

When it is not possible to perform surgery, the symptoms of the disease can be improved by performing a cardiac catheterization and placing a specific piece ("mitraclip") to reduce mitral regurgitation.

Which is the better alternative: cardiac surgery or cardiac catheterization?

Classic surgery is always the best alternative to restore the normal functioning of the valve, because it allows a complete repair of the functioning of the valve or the possibility of replacing it with a prosthesis. When cardiac surgery is not possible, catheterization can reduce the degree of mitral regurgitation, relieve symptoms and improve the patient's quality of life.

What is the recovery like after the different treatments?

Surgery requires a longer recovery, although it varies from case to case. Usually, it requires a hospitalization of 7 to 10 days, 1 month until complete healing and, in some cases, about 2 months until the return to normal activity><. Catheterization intervention requires a hospital stay of about 3 to 5 days and a period of about 1 to 2 weeks until normal activity returns.