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What Is Mitral Valve Disease?
The mitral valve is located between the heart's upper left chamber (the left atrium) and the heart's lower left chamber (the left ventricle).
When the heart contracts, the mitral valve's two flaps — or leaflets — open to allow blood to pass from the atrium to the ventricle. When the heart relaxes and the ventricle fills, the pressure causes the flaps to close.
Mitral valve disease is when your mitral valve stops opening and closing properly.
How common is mitral valve disease?
Mitral valve disease is among the most common heart valve problems, affecting millions of people in the U.S.
What are the types of mitral valve disease?
Types of mitral valve disease include:
- Mitral regurgitation – Mitral regurgitation occurs when your mitral valve no longer closes tightly. This allows blood to travel backward, from the ventricle to the atrium. The most common cause of mitral regurgitation or “leakage” is known as mitral valve prolapse.
- Mitral stenosis – Mitral stenosis is when the valve becomes restricted or partially blocked. This “blockage” prevents some of the blood from moving out of your atrium and into your ventricle.
What causes mitral valve disease?
The cause of mitral valve disease depends on whether you have mitral stenosis or mitral regurgitation.
What causes mitral stenosis?
Causes of mitral stenosis include:
- Blockage – As you age, calcium can build up around and on your mitral valve. This is the most common form of mitral stenosis.
- Infection – Rheumatic fever and scarlet fever in childhood may cause the leaflets of your valve to thicken or fuse over prolonged periods of time, preventing it from opening properly. This is the second most common cause of mitral stenosis.
- Other causes of mitral stenosis are:
- Radiation – Prior external radiation to your chest cavity during cancer treatment.
- Birth defects – History of congenital, or birth-related, abnormalities.
- Medications – Some drugs may cause mitral stenosis. These included certain migraine medications and older diet medications.
What causes mitral regurgitation?
Causes of mitral regurgitation include:
- Infection – A type of infection called endocarditis occurs when bacteria enter the blood stream and attach themselves to the mitral valve. This often happens in people with mitral valve prolapse. The most common cause of bacteria entering the bloodstream is from dental or oral sources. Endocarditis is the second most common cause of mitral regurgitation.
- Mitral valve prolapse – This happens when you are born with excess leaflet tissue, known as a “floppy mitral valve.” This may cause your mitral valve to leak as you age. This is the most common cause of mitral regurgitation.
- Other causes of mitral regurgitation are:
- Rheumatic fever – This childhood illness can lead to scarring of the leaflets, which may cause the valve to leak.
- Heart attack – A heart attack or lack of blood supply to the heart muscle can stretch the left ventricle and the mitral valve, causing it to leak.
What are mitral valve disease risk factors and complications?
Mitral valve disease risk factors
Risk factors for mitral valve disease include:
- Age.
- Congenital heart conditions.
- History of heart attack.
- History of rheumatic or scarlet fever.
- Radiation to the chest to treat cancer.
Complications of mitral valve disease
Without treatment, mitral valve disease can lead to:
- Heart failure– Heart failure occurs when your heart cannot pump enough blood to meet your body's needs.
- Heart enlargement.
- Atrial fibrillation (AFib) – AFib is the most common type of abnormal heart rhythm.
- Blood clots – AFib increases the risk of developing blood clots.
- Fluid build-up in the lungs.
- Sudden cardiac death – In rare situations, severe mitral valve disease can result in sudden death.
How serious is mitral valve disease?
If left untreated, mitral valve disease can cause serious complications that could become life-threatening. It’s important to talk to your doctor if you’re having symptoms of mitral valve disease and follow your doctor’s treatment recommendations.
How can I prevent mitral valve disease?
You may not be able to control some of your risk factors for mitral valve disease, such as aging and congenital conditions. However, eating a heart-healthy diet, maintaining a healthy weight, exercising regularly, quitting smoking, limiting alcohol, avoiding recreational drugs, and controlling chronic conditions such as high blood pressure and high cholesterol may help to lower your risk.
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What Are the Signs and Symptoms of Mitral Valve Disease?
Symptoms of mitral valve disease may include:
- Anxiety.
- A dry cough.
- Chest pain.
- Fatigue that gets worse with activity.
- Frequent lung infections, such as bronchitis.
- Heart palpitations, which may feel like a fluttering or fast heartbeat.
- Shortness of breath.
- Swelling of feet or ankles.
When should I see a doctor about my mitral valve disease symptoms?
If you think you may have heart valve disease, you should consult your doctor. If your symptoms are sudden and severe, dial 911 or visit the nearest hospital emergency room.
How do I know if my mitral valve is getting worse?
If your mitral valve condition is getting worse, you may notice that your symptoms are happening more often or getting more severe. If this is the case, schedule an appointment with your doctor as soon as possible.
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How Do You Diagnose Mitral Valve Disease?
Your doctor may diagnose a mitral valve problem during a physical exam by listening for a murmur (an abnormal heart sound) using a stethoscope.
What to expect during your visit
During your physical exam, your doctor will:
- Ask about your symptoms and when they started.
- Discuss your medical history.
- Listen to your heart with a stethoscope.
Your doctor may order further tests if they hear a heart murmur or if you are having symptoms.
Tests to diagnose mitral valve disease
Our experts use the latest diagnostic tests to learn about your heart valve condition, including:
- Cardiac catheterization – This diagnostic procedure involves the insertion of a tiny, hollow tube (catheter) through a large artery in your leg or arm leading to your heart in order to provide images of your heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.
- Chest x-ray – A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.
- CT angiogram – A CT angiogram is an imaging test that looks at the arteries that supply your heart muscle. This test uses a powerful x-ray machine to produce images of your heart and heart vessels.
- Echocardiogram (Echo) – This noninvasive ultrasound test uses sound waves to evaluate your heart’s chambers and valves. The echo sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
- Electrocardiogram (ECG or EKG) – This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
- Magnetic resonance imaging (MRI) – MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
- Transesophageal echocardiogram (TEE) – TEE is a form of echocardiography that is performed by inserting a probe with a transducer into your esophagus rather than placing the transducer on your chest as in a traditional echocardiogram. A TEE provides a clearer image of your heart because the sound waves do not have to pass through skin, muscle, or bone.
- Two-dimensional echocardiogram (2D Echo) – This test uses ultrasound to display a cross-sectional “slice” of your beating heart, including the chambers, valves, and the major blood vessels that exit from the left and right part of your heart.
Your doctor or nurse will tell you when to expect your test results and will call you when they're available.
Mitral valve disease prognosis
Early diagnosis and treatment of heart valve disease can improve your long-term outcomes and survival rate. Your doctor will discuss your prognosis with you.
Can you live with a bad mitral valve?
With proper treatment and follow-up care, many people with mitral valve disease live active and fulfilling lives.
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How Do You Treat Mitral Valve Disease?
Goals of treatment for mitral valve disease are:
- Improve life expectancy and quality of life.
- Limit or eliminate the blockage or leakage of your valve.
- Provide symptom relief.
Treatment options for mitral valve disease may include:
Ongoing monitoring
If your mitral valve disease is not severe, medications and close follow-up with frequent echocardiograms may be possible.
Surgery for mitral valve disease
Mitral valve disease is a mechanical problem with the flow of blood through your heart, so it is often best treated by fixing the valve with surgery.
Mitral valve repair for mitral regurgitation
The first line of treatment for mitral regurgitation, particularly for mitral valve prolapse, is mitral valve repair. This involves surgically restoring the normal function of the mitral valve by rebuilding the existing leaflets using several techniques tailored to the individual anatomy.
Mitral valve repair can often be performed using minimally invasive approaches through a small incision on the front of the chest, or, in some cases, through a small incision on the right chest.
Following mitral surgery, most of our patients are removed from the breathing machine quickly, if not in the operating room, and stay in the hospital an average of 3 to 5 days before returning home.
For the first 3 to 4 weeks of recovery, activity is strongly encouraged but heavy lifting and driving is restricted. After 3 to 4 weeks of recovery, a gradual full return to normal healthy activity, including driving, is encouraged.
Mitral valve replacement for mitral stenosis
For the treatment of mitral stenosis or when surgical repair is not possible, a mitral valve replacement is often the first line treatment. This involves surgically clearing the blockage of the valve while preserving the natural anatomy as much as possible.
Mitral valve replacement is performed with either a mechanical valve made of metal leaflets or a biologic valve made of cow or pig tissue.
- Mechanical valves are long-lasting, but due to their metallic leaflets, you must take blood-thinning medication for the rest of your life.
- Tissue valves do not last as long as mechanical valves. However, you may not need to take lifelong blood-thinning medications. Depending on your age and condition at the time of surgery, tissue valves may eventually need to be replaced.
Minimally invasive care for mitral valve disease
UPMC structural heart experts offer innovative, minimally invasive catheter-based procedures to treat mitral valve disease — without the need to open the chest.
These procedures are performed through a small incision in the groin and provide new treatment options for patients who are unable to have an open-heart procedure. Procedures include:
- MitraClip for mitral regurgitation – Approved by the U.S. Food and Drug Administration in October 2013, MitraClip may be used to improve mitral regurgitation symptoms and heart function in selected patients who are considered to be at too high risk for open surgery.
- Balloon mitral valvuloplasty for mitral stenosis – Balloon valvuloplasty is a minimally invasive procedure used to repair mitral valve stenosis. In valvuloplasty, an interventional cardiologist inserts a long balloon-tipped catheter into your heart across the mitral valve. Once in place, the balloon is inflated thus forcing the flaps of the valve apart. This helps the valve open wider to increase blood flow.
How effective is treatment?
At UPMC, surgeons perform mitral valve repair every day with an overall repair rate of over 98 percent. UPMC experts are also among the nation’s most experienced at performing mitral valve replacement procedures with outstanding patient outcomes.
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Why Choose UPMC for Mitral Valve Disease Care?
Our extensive experience allows us to provide the latest treatments for mitral valve disease, including:
- Complex valve reconstruction and repair.
- Minimally invasive mitral valve catheter-based techniques, such as mitral valvuloplasty and MitraClip.
Our team-based approach to care includes cardiac surgeons, interventional cardiologists, cardiologists, anesthesiologists, and nurses. Together, our team focuses on open communication while working with you, your family, and your primary care doctors to provide coordinated care to best meet your needs.
By UPMC Editorial Staff. Last reviewed on 2024-10-01.
