Features October 2011 Issue

Mitral Valve Regurgitation Can Often Be a Hidden Condition

The leaky valve is frequently discovered during a routine exam when a doctor picks up a murmur while listening to the heart.

It’s not the kind of news you expect to hear when you go in for a routine physical exam: “You may have mitral valve regurgitation.”

Mitral valve surgery involves repairing the leaflets or chords, often by making new chords of Gore-Tex and placing a cloth ring (annuloplasty), which acts like a washer, around the valve.

However, as heart complications go, mitral valve regurgitation is among the more treatable. If you have a mild condition, you may not need any treatment at all. Drugs cannot correct the problem with the valve itself, though if you have high blood pressure, which can make the valve disease worse, anti-hypertensive medications may help keep your valve disease from progressing.

In more serious cases, mitral valve repair is the preferred option. Advances in technology allow some repairs to be done through small incisions on the right side of the chest, rather than with open surgery.

Cleveland Clinic cardiac surgeon Marc Gillinov, MD, says repairing, rather than replacing, a leaky mitral valve provides better long-term survival odds, fewer complications and greater preservation of heart function. But he adds that mitral valve regurgitation is a disease that can sneak up on patients.

Such was the case earlier this year when a patient went in for a routine physical and her doctor told her he heard a murmur when listening to her heart. The woman’s story, which included a mitral valve repair by Dr. Gillinov, was featured on ABC’s Good Morning America in July.

Dr. Gillinov explains that the more serious symptoms associated with mitral valve regurgitation often don’t appear until after the condition has been developing for some time. “It’s detected by a murmur in most cases,” Dr. Gillinov says. “It is often asymptomatic initially. Over time, shortness of breath and fatigue develop.” Even these symptoms can be subtle.

Understanding Valve Disease
The mitral valve is located between the left atrium (an upper chamber) and the left ventricle (a lower chamber). The valve allows blood to flow from the atria to the ventricle, from which blood is pumped throughout the body. When the valve starts to function poorly, it may not close properly and blood can leak back from the ventricle.

When a doctor listens to your heart and hears a murmur, it’s really the sound of blood returning up into the atrium, a signal that the normal flow of blood through the heart has been disrupted.

The dangers of mitral valve regurgitation can include heart failure, in which the heart is not strong enough to pump blood efficiently to the rest of the body, and arrhythmias.

Risk and Treatment
Those at risk of mitral valve disease include heart attack patients, those who have had infections such as rheumatic fever and people born with congenital heart problems.

But a common risk factor is simply age. Over time, the valve can deteriorate, which appeared to be the case with the patient featured on ABC News. If the deterioration is minor and heart function remains healthy, it may be a matter of watching and waiting. Your physician will gauge the degree of leakage on a scale of one to four, with four being the most serious.

“The condition can remain stable for years,” Dr. Gillinov says. “If the valve leaks at a level of two or greater, get an echocardiogram every year.”
If your doctor determines that your valve disease is putting your health in jeopardy, a repair will probably be recommended.

“We perform most of our isolated mitral repairs through small incisions and robotic approaches,” Dr. Gillinov says. “If a person also needs other heart surgery, such as repair of other valves or bypass surgery, we may need to do a traditional open procedure. For a minimally invasive or robotic approach, there are no restrictions. Most people feel about 90 percent themselves by about three weeks.”

Dr. Gillinov says there’s a 90 percent chance a repaired mitral valve will last 20 years or more.

“Most repairs never fail,” he says. “And issues with repairs, if they occur, are picked up on an annual echo.”

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