Mitral valve regurgitation

Diagnosis

A physical examination, questions about the signs and symptoms, and a medical history are typically used to evaluate whether the patient have mitral valve regurgitation.

If during the assessment the specialist hears a heart murmur (whooshing sound of the heart), the patient will be referred to a cardiologist.

Mitral valve regurgitation can be detected using a number of investigations, including:

• Echocardiogram: Images of the beating heart are produced by sound waves that are being sent by the heart using a transducer, that is held on the chest. The test assesses the severity, the cause and the condition of the heart valve.

The mitral valve may be examined more closely using a transesophageal echocardiography (TTE) which involves inserting a small transducer end tube from the mouth and down to your esophagus.

• Electrocardiogram (ECG): A doctor places pads of electrodes on skin to monitor and find any abnormalities in the electrical activities of the heart, such as arrhythmias that are caused by mitral valve regurgitation.
• Chest X-ray: The health of the heart and lungs can be seen on a chest X-ray. It can detect cardiac enlargement or a fluid buildup in the lungs.
• Cardiac magnetic resonance imaging (MRI): shows the severity and size of the valve regurgitation through detailed pictures of the heart using magnetic fields and radio waves. Cardiac MRI also helps detect abnormalities in the left ventricle.
• Exercise tests or stress tests: In these tests, an ECG or echocardiogram is frequently performed while the patient walks on a treadmill or on a stationary bike. Exercise test can aid to determine how the heart is responding to exercise and whether exercising will trigger development of the heart symptoms. If the patient is unable to perform the test, they may be able to benefit from using medications that have the same heart-healthy effects as exercise.
• Cardiac catheterization:  In some cases that other tests have failed to diagnosis and show the severity, this test can be used for diagnosis of mitral valve regurgitation.

The procedure will insert a narrow tube (catheter) into a blood vessel, commonly at the arm or groin before being guided to an artery of the heart. Contrast material might also be given through the catheter to create clearer X-ray pictures of the heart chambers.

Staging

Once the doctor can confirm the diagnosis of mitral valve regurgitation, they will stage the disease to choose the best treatment option. There are many factors that determine the stage of your mitral valve regurgitation such as the severity level, the valve’s structure, and how blood is pumped through the heart and lungs.
In general, there are four stages to heart valve disease:

• Stage A: At risk. There are some risk factors for heart
  valve disease.
• Stage B: Progressive. Mild to moderate valve disease
  exists and heart valve symptoms are absent.
• Stage C: Asymptomatic severe. Severe valve disease
  exists but heart valve symptoms are absent.
• Stage D: Symptomatic severe. Severe valve disease
  that manifests symptoms.

Treatment

In general, mild mitral valve regurgitation does not need treatment. There are many treatment options, and the doctor will select the most suitable one by taking its symptoms and stage into account.

• Changing habits to make the lifestyle healthier
• Receiving a health checkup from time to time
• Taking medications to control the disease and prevent blood clots and other complications
• Undergoing mitral valve repair or replacement surgery

Patients with mitral valve regurgitation are recommended to receive treatment from a cardiologist at a medical institute with a specialized and experienced multidisciplinary team.

Medications

A doctor might prescribe medications to control the symptoms of mitral valve regurgitation and prevent development of possible complications.

Medications to treat this heart valve disease include:

• Diuretics. These water pills alleviate or prevent fluid buildups in any organ of the body, including the lungs.
• Blood thinners. These anticoagulants are useful for treating atrial fibrillation that is caused by mitral valve regurgitation or any other valve-related disease. As atrial fibrillation can cause blood clots and strokes, blood thinners are prescribed to lower the chance of developing any of these complications.
• Blood pressure medications. A doctor sometimes controls mitral valve regurgitation by prescribing medications that lower the blood pressure.

Surgery or other procedures

This kind of treatment aims to repair or replace the mitral valve and is recommended to patients with asymptomatic regurgitation. The risks will be discussed, and the most suitable treatment way will be chosen.

To treat the mitral valve, a doctor usually make an incision in the chest, but in some institutes doctor may perform robot-assisted heart surgery, where robotic arms are used to perform the treatment as a minimally invasive procedure.

Mitral valve repair

A doctor performs mitral valve repair surgery to prevent the valve from becoming unfunctional and to keep the heart working properly. If the repair surgery fails to treat the disease, the doctor might then consider valve replacement surgery.

The process of mitral valve repair surgery includes:

• Filling holes of a heart valve with patches
• Reconnect a valve that is unnaturally torn
• Remove any extra tissue from the valve so that the flaps can firmly close
• Replacing the cords of the mitral valve to make the valve structure return to normal
• Separating valve leaflets that have fused

Other mitral valve repair procedures include:

• Annuloplasty: the ring of a valve is tightened to repair a heart valve and can be done together with other procedures.
• Valvuloplasty: a doctor inserts a catheter into an artery of the arm or groin with a balloon attached on the tip before guiding the catheter to the mitral valve. Then the doctor will try to repair and widen a mitral valve whose opening is narrowing by inflating the balloon. The doctor will remove the catheter and balloon from the body. This kind of treatment might be suitable for those with asymptomatic mitral valve regurgitation too.
• Mitral valve clip: a cardiologist inserts a catheter into an artery of the groin with a clip on the tube’s end to the mitral valve and then use the clip to help make the mitral valve leaflets close more firmly to improve the blood leakage condition.

Mitral valve replacement

A doctor sometimes treats mitral valve regurgitation by removing the valve itself and replacing it with a mechanical valve or a biological tissue valve made from cow, pig or human heart tissue.

If a biological tissue valve starts to work less effectively, a doctor might do a valve-in-valve procedure, using a catheter to place another biological tissue valve into the current one. As biological tissue valves degenerate over time, they need to be replaced too.

As a mechanical valve can cause blood clots, those undergoing mechanical valve replacement surgery are required to take blood thinners for the rest of their life.