Patients with moderate to severe mitral regurgitation are at risk to develop shortness of breath, heart failure, and damage to the main pump of the heart.
Mitral regurgitation is a very common problem, affecting almost 10% of patients over the age of 75. If left untreated, severe mitral regurgitation can lead to progressive weakening of the heart muscle, progressive heart failure symptoms, and even death.
Symptoms of Mitral Regurgitation
Mild and moderate mitral regurgitation usually has no symptoms and often does not require specific therapy. Patients that have more severe mitral regurgitation, however, do often have symptoms, including:
- Fatigue with exertion
- Shortness of breath with exertion
- Heart failure symptoms including shortness of breath when laying down and swelling of the legs
- Heart rhythm difficulties including atrial fibrillation
How to Test for Mitral Regurgitation
Mitral valve regurgitation can often be identified by listening to the heart with a stethoscope. The leaking valve frequently makes a characteristic noise, or murmur, when the heart pumps.
Echocardiography, or ultrasound of the heart, is a noninvasive test which can further characterize and quantify the severity of mitral regurgitation.
Transesophageal echocardiography is an ultrasound procedure done in the hospital. After receiving sedation to make them comfortable, patients swallow an ultrasound probe to allow close-up pictures to be taken of the heart, from the patient’s esophagus. This is a similar procedure to endoscopy.
Mitral Regurgitation Treatment Options
Treatment for patients with symptomatic mitral regurgitation varies depending on the cause of the regurgitation.
If the primary problem is with the valve itself—that is, if you have degenerative or primary mitral valve disease—then surgical mitral valve repair, valve replacement, or catheter-based repair (also called TMVR, or transcatheter mitral valve repair) are the therapies of choice.
Surgical mitral valve repair is the gold standard therapy for patients who are good surgical candidates. If patients are high risk for surgery, then TMVR should be considered.
Treatment of symptomatic mitral regurgitation that results from prior heart attack or a weakened heart muscle includes optimal medical therapy for heart failure, and may additionally include surgical valve repair/replacement, special pacemaker placement, or TMVR/MitraClip therapy.