Mitral Valve Regurgitation (Mitral Insufficiency)

The mitral valve, which is found between the heart's left upper and lower chambers, has two flaps. These flaps open and close to control blood flow through your heart.

Mitral valve regurgitation (MR), or mitral insufficiency, occurs when your mitral valve no longer closes tightly, causing blood to flow the wrong way.

At UPMC, we use the latest technology to diagnose and treat MR. Whether you need medicine or surgery for mitral valve regurgitation, we ensure you get the right care.

Looking for Mitral Valve Regurgitation (MR) Care? 

• What Is Mitral Valve Regurgitation (MR)?
• What Are the Symptoms of Mitral Valve Regurgitation?
• How Do You Diagnose Mitral Valve Regurgitation?
• How Do You Treat Mitral Valve Regurgitation? 

What Is Mitral Valve Regurgitation?

The mitral valve is a one-way valve between the heart's left upper and lower chambers.

When the heart contracts, the mitral valve's two flaps open to let blood flow from the upper chamber to the lower one.

Mitral regurgitation occurs when the mitral valve doesn't close properly, allowing blood to leak back into the heart's left upper chamber.

How common is MR?

MR, or mitral insufficiency, is one of the more common types of heart valve disorders.

What causes MR?

Mitral valve prolapse

The most common cause of MR is mitral valve prolapse.

This occurs when you're born with excess leaflet tissue, known as a "floppy mitral valve." As you age, this condition makes the valve prone to leak.

Mitral valve prolapse causes one or both of the valve's two flaps to stretch or get too large. This may prevent the valve from closing tightly.

Over time, one of the flaps may rupture from its attachment to the heart muscle, leading to worsening valve leakage. This type of mitral regurgitation is called degenerative regurgitation.

Endocarditis

Another common cause of MR is endocarditis, a bacterial infection. It often occurs in people with pre-existing mitral valve prolapse.

Bacteria enter the bloodstream — often from dental procedures or poor oral health — and attach to the valve, causing an infection.

Taking antibiotics before you have dental work can help prevent infection.

Other causes of MR

Other well-known causes of MR include:

• Congenital malformation of the flaps – Some people are born with damage to the flaps, causing the valve to work improperly.
• Connective tissue or systemic inflammatory diseases – Conditions such as Marfan syndrome, Ehlers-Danlos syndrome, scleroderma, and lupus have become linked to MR.
• Heart attack or lack of blood supply to the heart muscle – This can stretch the heart's left lower chamber and the mitral valve, causing it to leak. This is called functional or ischemic MR.
• Irregular heart rhythms, such as AFib – Abnormal heart rhythms lead to stretching of the heart's left upper chamber and the mitral valve. This is also a type of functional or secondary MR.
• Radiation and certain drugs – Medications and treatments may damage the valve or affect how it works.
• Rheumatic fever – This childhood illness can lead to scarring of the flaps and cause the valve to leak.
• Trauma – Traumatic injury can lead to a rupture of the valve apparatus.

What are MR risk factors and complications?

MR risk factors

People with conditions that can harm the valve or flaps or affect the valve's function are at higher risk for MR. Factors that increase your risk of MR include:

• Age.
• Certain medicines.
• Connective tissue disease, such as Ehlers-Danlos or Marfan syndrome.
• Heart attack.
• Long-standing atrial fibrillation (AFib).
• Mitral valve prolapse or mitral stenosis.
• Prior chest radiation.
• Rheumatic fever as a child.
• Systemic inflammatory disease, such as scleroderma or lupus.

Complications of MR

Without treatment, MR can lead to complications such as:

• Common heart rhythm problems such as AFib – Changes in heart rhythm can occur when mitral regurgitation causes the upper left chamber to get larger.
• Heart enlargement – The upper or lower left chamber can get larger or widen when the heart has to strain to pump blood.
• Heart failure requiring a hospital stay – MR causes the heart to work harder to pump blood throughout the body. Over time, the heart muscle weakens, causing it to fail.
• Rare heart rhythm problems such as premature ventricular contractions – Heart enlargement can lead to changes in the heart's rhythm.

Very rarely, MR caused by severe mitral valve prolapse can lead to sudden death.

How serious is mitral regurgitation?

If left untreated, mitral regurgitation can cause serious complications that could become life-threatening. It’s important to talk to your doctor if you’re having symptoms of MR and follow your doctor’s treatment recommendations.

How can I prevent mitral valve regurgitation?

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.

What should I avoid if I have mitral valve regurgitation?

If you have mitral valve regurgitation, you should take steps to keep your heart healthy and avoid:

• Excessive alcohol consumption.
• Recreational drugs.
• Smoking.

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What Are the Signs and Symptoms of MR?

MR can exist for years without causing major symptoms. When symptoms do occur, they can include:

• Anxiety.
• Chest pain.
• Coughing — often a dry cough.
• Fatigue or feeling tired.
• Heart palpitations or feeling your own heartbeat.
• Shortness of breath, often worse with activity.
• Swelling of feet or ankles.

When should I see a doctor about my MR symptoms?

You should call a doctor if you have:

• Trouble breathing when exercising, with exertion, or at rest.
• New swelling of the legs, feet, or ankles.

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How Do You Diagnose MR?

Your doctor will ask about your medical history and do a physical exam. MR often causes murmurs or strange sounds of blood flowing through your heart.

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 MR

Tests your doctor may use to diagnose MR include:

• Chest x-ray – Lets your doctor see the size and shape of your heart.
• Echocardiogram (ECHO) – A heart ultrasound that uses sound waves to make images of the structures of your heart. This is often the first step.
• Electrocardiogram (EKG) – Measures the electrical activity of your heart.
• Heart catheterization – An outpatient test that lets the doctor see blood flow through your heart and its arteries.
• MRI scan – Uses a magnet and radio waves to take pictures of your mitral valve.
• Transesophageal echocardiogram (TEE) – An outpatient test that uses sound waves like a standard ECHO but is done within your esophagus. TEE gives doctors precise images of the heart valve, often in 3D. It is one of the best ways to diagnose MR correctly.

MR prognosis

Early diagnosis and treatment of MR can improve your long-term outcomes and survival rate. Your doctor will discuss your prognosis with you.

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How Do You Treat MR?

Goals of treatment for MR are:

• Improve life expectancy and quality of life.
• Limit or eliminate the leakage of your valve.
• Provide symptom relief.

For mild MR, medicine and close follow-up with frequent echocardiograms are often all you need.

However, because MR is caused by a mechanical problem, valve repair or replacement is often the best treatment option.

Doctors at UPMC are experts in minimally invasive and surgical techniques for repairing your mitral valve. Your doctor will use the approach that best meets your needs, which may include:

Valve repair surgery for mitral regurgitation

What is the best treatment for mitral valve regurgitation?

The first line treatment for MR, especially for mitral valve prolapse, is valve repair surgery.

This involves surgery to restore your mitral valve's normal function by rebuilding your existing flaps. We tailor the technique to your anatomy.

Minimally invasive mitral valve surgery

Minimally invasive approaches to mitral valve repair involve making a small incision on the front or right side of the chest. This technique is less invasive than open chest surgery.

These smaller cuts to access the heart may lead to:

• Faster recovery, allowing you to get back to your life sooner.
• Less pain and blood loss.
• Reduced risk of infection.

After minimally invasive mitral valve repair surgery, most people:

• Can do some activities the first 3-4 weeks post-op, avoiding heavy lifting and driving. Your doctor will explain what you can and can't do.
• Get off the breathing machine quickly, sometimes while still in the OR.
• Stay in the hospital for 3-5 days before going home.

After 3-4 weeks of recovery, you can slowly return to normal activity, including driving.

Minimally invasive robotic-assisted mitral valve surgery

UPMC is a leader in minimally invasive robotic mitral valve repair.

This allows the surgical team to access the mitral valve directly — often through a 2-inch incision — with technical and imaging precision.

It's the preferred treatment for people with isolated MR due to mitral valve prolapse.

Compared to some other types of surgery, robotic mitral valve repair:

• Avoids disturbance to the ribs or chest.
• Causes less pain.
• Allows for a faster recovery and return to your daily routine.

Transcatheter edge-to-edge repair (TEER)

UPMC is a leader in transcatheter edge-to-edge repair, a minimally invasive approach to MR valve repair. UPMC experts perform this procedure through a vein in the leg. The surgeon passes a catheter with a clip into the heart and uses the clip to bring the mitral valve's two flaps together.

UPMC uses two commercially available systems: Abbott's MitraClip System and Edwards' Pascal Precision System. Surgeons often use the TEER technique to treat people who are too high risk for heart valve surgery.

Mitral valve replacement surgery

Mitral valve repair is always the first approach to treat MR, especially for people with degenerative or "floppy" valves. Our team may perform a mitral valve replacement for moderate to severe cases of MR if repairing the valve isn't an option because of:

• Heavy calcium.
• Infection.
• Severe stretching from heart failure.

We replace the mitral valve with a valve made of either metal flaps (mechanical) or cow or pig tissue (biologic).

• Metal valves are long-lasting but require you to take a blood thinner for life.
• Tissue valves don't last as long as metal ones but often don't require you to take lifelong blood thinners. Depending on your age and condition at the time of surgery, tissue valves may eventually need replacement.

How effective is treatment?

At UPMC, the team performs mitral valve repair procedures daily with a more than 90 percent repair rate. Our mitral valve replacement procedures have similar outcomes, with most otherwise healthy patients returning to a normal, active lifestyle after surgery.

What is the life expectancy of someone with mitral regurgitation?

People with untreated mitral regurgitation are at higher risk of developing heart failure and other complications that could limit life expectancy. However, after treatment, most people with MR have the same life expectancy as an otherwise healthy person without valve disease.

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Why Choose UPMC for MR Care?

At the UPMC, we provide a team-based approach to:

• Tailor mitral valve regurgitation treatment plans to your unique needs.
• Help you enjoy an improved quality of life.
• Provide the latest minimally invasive mitral valve surgical techniques, such as the MitraClip_^®, backed by our own research.

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By UPMC Editorial Staff. Last reviewed on 2024-10-01.