Mitral valve disease

Mitral valve disease is a problem with the valve located between the left heart chambers (left atrium and left ventricle).

Mitral valve disease includes:

• Mitral valve regurgitation. The mitral valve flaps (leaflets) may not close tightly, causing blood to leak backward.
• Mitral valve stenosis. The flaps of the mitral valve become thick or stiff, and they can fuse together. This narrows the valve opening, which reduces blood flow from the left atrium to the left ventricle.

Treatment for mitral valve disease depends on the severity of the condition and whether it is worsening. Sometimes, surgery is recommended to repair or replace the mitral valve.

Symptoms

Some people with mitral valve disease might not have symptoms for many years, if at all.

Signs and symptoms of mitral valve disease can include:

• Fatigue
• Irregular heart sound (heart murmur)
• Irregular heartbeat
• Shortness of breath

When to see a doctor

If you have a heart murmur or develop other signs or symptoms of mitral valve disease, your health care provider might recommend that you visit a doctor that specializes in heart diseases (cardiologist).

Causes

To understand the causes of mitral valve disease, it may be helpful to know how the heart works.

The mitral valve is one of four valves in the heart that keep blood flowing in the right direction. Each valve has flaps (leaflets) that open and close once during each heartbeat. If a valve doesn't open or close properly, blood flow through the heart to the body can be reduced.

In mitral valve regurgitation, the flaps don't close tightly. Blood flows backward when the valve is closed, making it harder for the heart to work properly.

In mitral valve stenosis, the valve opening narrows. The heart now must work harder to force blood through the smaller valve opening. If the opening in the valve becomes small enough, it can reduce blood flow from the left atrium to the left ventricle.

Mitral valve disease has many causes. Some forms of mitral valve disease can be present at birth (congenital heart defect).

Mitral valve disease may also develop later in life (acquired). For example, mitral valve stenosis is often caused by rheumatic fever. This fever is a complication of a strep infection that can affect the heart. When this happens, it's called rheumatic mitral valve disease.

Other causes of acquired mitral valve disease include:

• Other heart conditions
• Infection
• Age-related changes
• Autoimmune disease, such as lupus

Risk factors

Several things can increase the risk of mitral valve disease, including:

• Older age
• Certain infections that affect the heart
• Heart attack and some types of heart disease
• Use of certain drugs
• Heart condition present at birth (congenital heart defect)
• Radiation to the chest

Complications

Mitral valve disease can cause many complications. Severe mitral valve regurgitation, for example, causes the heart to work harder, which can cause the left ventricle to enlarge and the heart muscle to weaken.

Other complications of mitral valve disease may include:

• Irregular and often rapid heart rate (atrial fibrillation)
• High blood pressure in the blood vessels in the lungs (pulmonary hypertension)
• Blood clots
• Congestive heart failure
• Stroke

Diagnosis

To diagnose mitral valve disease, including mitral valve stenosis and mitral valve regurgitation, a health care provider will usually perform a physical exam and ask questions about your medical history.

The health care provider will listen for a heart murmur, a sign of a mitral valve condition.

Tests to diagnose mitral valve disease may include:

• Echocardiogram. Sound waves are used to produce video images of the heart in motion. An echocardiogram provides a closer look at the mitral valve and how well it's working. An echocardiogram can help in the diagnosis of congenital mitral valve disease, rheumatic mitral valve disease and other heart valve conditions.

  Sometimes, a transesophageal echocardiogram 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).

• Electrocardiogram (ECG or EKG). Wires (electrodes) attached to pads on the skin measure electrical signals from the heart. An ECG can detect enlarged chambers of the heart, heart disease and irregular heart rhythms.
• Chest X-ray. A chest X-ray can show the condition of the heart and lungs. It can reveal whether the heart is enlarged, which can be a sign of certain types of heart valve disease.
• Cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart. A cardiac MRI might be done to determine the severity of mitral valve disease.
• Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests help reveal how the heart responds to physical activity and whether valve disease symptoms occur during exercise. If you're unable to exercise, you might be given medications that mimic the effect of exercise on your heart.

• Cardiac catheterization. A health care provider threads a thin tube (catheter) through a blood vessel in the arm or groin to an artery in the heart and injects dye through the catheter. This makes the heart arteries show up more clearly on an X-ray.

  Cardiac catheterization isn't often used to diagnose mitral valve disease, but it can be used if other tests haven't diagnosed the condition or to check to see if coronary artery disease is present.

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:

• Stage A: At risk. Risk factors for heart valve disease are present.
• Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
• Stage C: Asymptomatic severe. There are no heart valve symptoms, but the valve disease is severe.
• Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.

Treatment

Mitral valve disease treatment depends on the symptoms, the severity of the condition, and whether the condition is worsening.

A doctor trained in heart disease (cardiologist) typically provides care for people with mitral valve disease. Treatment of mitral valve disease might include monitoring the condition with regular follow-up visits. If you have mitral valve disease, you might be asked to:

• Make healthy lifestyle changes
• Take medications to treat symptoms
• Take blood thinners to reduce the risk of blood clots if you have a certain irregular heart rhythm called atrial fibrillation

Surgery or other procedures

A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if no symptoms are present. Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement.

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

Surgeons at some medical centers perform robot-assisted heart surgery, a type of minimally invasive heart surgery in which robotic arms are used to conduct the procedure.

Mitral valve repair

During mitral valve repair surgery, the doctor might:

• Patch holes in a heart valve
• Reconnect the valve flaps
• Remove excess tissue from the valve so that the flaps can close tightly
• Repair the structure of the mitral valve by replacing cords that support it
• Separate valve leaflets that have fused

Other mitral valve repair procedures include:

• Annuloplasty. A surgeon tightens or reinforces the ring around the valve (annulus). Annuloplasty may be done with other techniques to repair a heart valve.
• Valvuloplasty. This catheter procedure is used to repair a mitral valve with a narrowed opening. Valvuloplasty might be done even if you don't have symptoms. The surgeon inserts a catheter with a balloon on the tip into an artery in the arm or groin and guides the catheter to the mitral valve. The balloon is inflated, widening the mitral valve opening. The balloon is deflated, and the catheter and balloon are removed.
• Mitral valve clip. In this procedure, a surgeon guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip is used to fix a torn or leaky mitral valve leaflet. This procedure is an option for people who have severe mitral valve regurgitation or who aren't a good candidate for mitral valve surgery.

Mitral valve replacement

During mitral valve replacement, the heart 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).

In some cases, a heart catheter procedure may be done to insert a replacement valve into a biological tissue valve that is no longer working properly. 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 the rest of your life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.

Lifestyle and home remedies

You'll have regular follow-up appointments with your health care provider to monitor your condition.

It's also important to make heart-healthy lifestyle changes, including:

• Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
• Maintaining a healthy weight. If you are overweight or have obesity, your health care provider might recommend that you lose weight.
• Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
• Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
• Avoiding tobacco. If you smoke, quit. Ask your health care provider about resources to help you quit smoking. Joining a support group may be helpful.

If you have mitral valve disease and want to become pregnant, it's important to talk with a health care provider first. A health care provider can discuss which medications are safe to take during pregnancy, and whether a procedure is needed to treat a heart valve condition before pregnancy. Women with heart valve disease usually require close monitoring by a health care provider during pregnancy.

Coping and support

If you have mitral valve disease, here are some steps that may help you manage your condition:

• Take medications as prescribed. Take your medications as directed by your health care provider.
• Get support. Having support from your family and friends can help you cope with your condition. Ask your health care provider about support groups that may be helpful.
• Stay active. It's a good idea to stay physically active. Your health care provider may give you recommendations about how much and what type of exercise is appropriate for you.

Preparing for an appointment

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

What you can do

• Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
• Write down your symptoms, including any that seem unrelated to mitral valve disease.
• Write down key personal information, including a family history of heart disease, and any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you take.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
• Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk about challenges you might face in getting started.
• Write down questions to ask your health care provider.

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

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What tests will I need?
• What's the best treatment?
• What are the alternatives to the primary approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• If I need surgery, which surgeon do you recommend for heart valve surgery?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your health care provider is likely to ask you several questions, including:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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