Diagnosis
To diagnose mitral valve regurgitation, a healthcare professional examines you. You're usually asked questions about your symptoms and medical history. The healthcare professional uses a device called a stethoscope to listen to your heart and lungs. If you have mitral valve regurgitation, a whooshing sound called a murmur may be heard. The mitral valve heart murmur is the sound of blood leaking backward through the valve.
You may have tests to confirm a diagnosis of mitral valve regurgitation or to check for other conditions that can cause similar symptoms.
Tests
Echocardiogram
A healthcare professional performs an echocardiogram at Mayo Clinic.
Common tests to diagnose mitral valve regurgitation include:
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Echocardiogram. Sound waves are used to create pictures of the beating heart. An echocardiogram shows the structure of the mitral valve and blood flow in the heart. A standard echocardiogram is called a transthoracic echocardiogram, also known as a TTE. It can confirm mitral valve regurgitation and show how severe the condition is. Echocardiography also can help diagnose congenital mitral valve disease, rheumatic mitral valve disease and other heart valve conditions.
Sometimes, a more detailed echocardiogram is needed to better see the mitral valve. This test is called a transesophageal echocardiogram, also called a TEE. A TEE takes pictures of the heart from inside the body.
- Electrocardiogram, also called an ECG or EKG. This test shows how the heart is beating. Sticky patches with sensors on them stick to the chest and sometimes the arms and legs. Wires connect the patches to a computer, which displays or prints results. An ECG can show irregular heartbeats that may be caused by mitral valve disease.
- Chest X-ray. A chest X-ray shows the condition of the heart and lungs. It can help diagnose an enlarged heart or fluid in the lungs.
- Cardiac MRI. Magnetic fields and radio waves are used to make detailed pictures of the heart. Cardiac MRI may help tell how severe mitral valve regurgitation is. The test also gives details about the lower left heart chamber.
- Exercise stress test. This test often involves walking on a treadmill or riding a stationary bike while the heart is checked. It shows how the heart reacts to exercise. An exercise stress test can show whether mitral valve regurgitation symptoms happen during exercise. If you can't exercise, you might get medicine that makes the heart work like exercise does.
- Cardiac catheterization. This test isn't often used to diagnose mitral valve disease. But it can be helpful if other tests haven't diagnosed the condition. A doctor guides a thin, flexible tube called a catheter through a blood vessel in the arm or groin. It's moved to an artery in the heart. Dye flows through the tube. This makes the arteries in the heart chambers show up more clearly on X-rays taken during the test.
Staging
After testing confirms a diagnosis of mitral or other heart valve disease, your healthcare team 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.
Outlook
How well a person does after being diagnosed with mitral valve regurgitation varies. This is called the outlook, also called prognosis. The outlook for mitral valve regurgitation depends on:
- The cause of the mitral valve disease.
- The stage of heart valve disease.
- The severity of regurgitation.
- How long the condition has been present, also called the duration.
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Treatment
The goals of mitral valve regurgitation treatment are to:
- Help the heart work better.
- Reduce symptoms.
- Prevent complications.
Some people, especially those with mild regurgitation, might not need treatment. Your healthcare team considers your symptoms, stage of valve disease and your overall health when planning treatment.
Treatment of mitral valve regurgitation may include:
- Healthy lifestyle changes.
- Regular health checkups.
- Medicines to treat symptoms and prevent complications, such as blood clots.
- Surgery to repair or replace the mitral valve.
A doctor trained in heart diseases typically cares for people with mitral valve regurgitation. This type of healthcare professional is called a cardiologist.
If you have mitral valve regurgitation, consider being treated at a medical center with a multidisciplinary team of healthcare professionals trained and experienced in evaluating and treating heart valve disease.
Medications
You may need medicines to reduce mitral valve regurgitation symptoms and to prevent complications.
Types of medicines that may be used for mitral valve regurgitation include:
- Water pills, also called diuretics. This type of medicine reduces or prevents fluid buildup in the lungs and other parts of the body.
- Blood thinners, also called anticoagulants. If you have atrial fibrillation due to mitral valve disease, such as mitral valve regurgitation, you may get these medicines to prevent blood clots. Atrial fibrillation increases the risk of blood clots and stroke.
- Blood pressure medicines. High blood pressure makes mitral valve regurgitation worse. If you have mitral valve regurgitation and high blood pressure, you may get medicines to lower blood pressure.
Surgery or other procedures
A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don't have symptoms. Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement. Your healthcare team talks with you about the risks and benefits of each type of heart valve to decide which valve may be best for you.
If you need surgery for another heart condition, a surgeon might do mitral valve repair or replacement at the same time as that other surgery.
Mitral valve surgery is usually done through a cut in the chest. Surgeons at some medical centers sometimes use robot-assisted heart surgery. This is a minimally invasive procedure in which the doctor uses robotic arms to do the surgery.
Robot-assisted minimally invasive mitral valve repair at Mayo Clinic
In robot-assisted mitral valve repair surgery at Mayo Clinic, two board-certified cardiac surgeons use robotic equipment to perform the exact same procedure conducted in traditional open chest heart surgery, without needing to make a large incision through your breast bone. Your surgeons perform the procedure through small incisions in your right chest, using finger-sized instruments that are slipped in between your ribs. In this procedure, one surgeon sits at a remote console and views your heart using a magnified high-definition 3D view on a video monitor. Another surgeon works at the operating table and ensures the safe movement of the robotic arms. You'll need to be supported by a heart-lung bypass machine during the procedure. This will allow your surgeons to stop your heart briefly and insert instruments into the inner chambers to repair the mitral valve. Your surgeon uses robotic arms to duplicate specific maneuvers used in open-chest surgeries. The procedure is performed through small openings in your chest, through which will be inserted micro instruments and a thin high-definition camera tube or thoracoscope. One opening will be a mini working port through which surgeons will insert materials used during the procedure. Your surgeon performs the procedure from the remote console. Your surgeon's hand movements are translated precisely to the robotic arms at the operating table, which move like a human wrist. At the operating table, another surgeon works together with the surgeon at the console to perform the procedure and ensure it is conducted safely and efficiently. Your surgeon at the console can closely examine the complicated mitral valve problem using the high-definition 3D video monitor. This allows your surgeon to have a clearer, more lifelike perspective of your heart than is possible during open heart surgery, in which surgeons view the heart from a further distance.
To repair the mitral valve, your surgeon makes an incision in the left upper chamber or left atrium of your heart to access the mitral valve. Your surgeon can then identify the problem with your mitral valve and repair the valve itself. In mitral valve prolapse, the mitral valve, located between your heart's left atrium and the left lower chamber or left ventricle, doesn't close properly. The leaflets of the valve bulge or prolapse upward or back into the left atrium as your heart contracts. This leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation. To repair this condition, various complicated technical procedures are performed. Sometimes a small section of the leaflet, the part of the valve that doesn't close properly, is identified, and a triangular section is removed, as shown. Your surgeon then stitches the cut edges of the leaflet together to repair the valve.
In other cases, new chords or chordae supporting the broken leaflet are inserted. An annuloplasty band is then placed around the circumference of the valve to stabilize the repair. Your surgeon will close the incisions in your chest after the procedure. Mayo's staff will assist you during your recovery over a three-day period in the hospital. In robot-assisted heart surgery, most people have a quicker recovery, smaller incisions, and less pain than following open-chest surgery. Studies have also found that this procedure performed at Mayo Clinic is cost effective, with similar or lower total costs compared with traditional open-chest surgery.
Mitral valve repair
Mitral valve repair
Mitral valve repair
In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve, called the annulus, by placing an artificial ring called an annuloplasty band.
Mitral valve repair saves the existing valve. It also may protect how the heart works. Whenever possible, surgeons recommend mitral valve repair before valve replacement. People who have valve repair for mitral regurgitation at an experienced medical center generally have good outcomes.
During mitral valve repair surgery, the surgeon 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 connected.
Other mitral valve repair procedures include:
- Annuloplasty. A surgeon tightens or reinforces the ring around the valve, called the annulus. Annuloplasty may be done with other methods to repair a heart valve.
- Valvuloplasty. This treatment is used to fix a mitral valve with a narrowed opening. You may have this treatment even if you don't have symptoms. It's done using a thin tube called a catheter with a balloon on the tip. The surgeon inserts the tube into an artery in the arm or groin and guides it to the mitral valve. The balloon is inflated. This makes the valve opening wider. The balloon is then deflated. The catheter and balloon are removed.
- Mitral valve clip. In this treatment, a doctor guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip helps the mitral valve flaps close more tightly. The treatment reduces the amount of blood moving backward across the valve. This treatment is an option for people who have severe mitral valve regurgitation or who aren't good candidates for mitral valve surgery.
Mitral valve replacement
Repair of previously replaced valve
Repair of previously replaced valve
If a previously replaced mitral valve has a leak surrounding the artificial valve, a cardiologist may insert a device to stop the leak.
During mitral valve replacement, the surgeon removes the mitral valve. It's replaced with a mechanical valve or a valve made from cow, pig or human heart tissue. A tissue valve also is called a biological tissue valve.
Sometimes, doctors use thin tubes called catheters to put a replacement valve into a biological tissue valve that no longer works well. This is called a valve-in-valve procedure.
If you have a mechanical valve, you need blood thinners for life to prevent blood clots. Biological tissue valves can break down over time and may need to be replaced.
If you've had mitral valve replacement, your healthcare professional usually tells you to take antibiotics before dental procedures. This helps prevent a heart infection called infective endocarditis.
Mayo Clinic Minute: Mitral valve clip
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Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and home remedies
Lifestyle changes are an important part of mitral valve disease treatment. They help keep your heart healthy. Take these steps:
- Don't smoke or use tobacco. Smoking is a major risk factor for heart disease. If you smoke and can't quit, talk with your healthcare team about programs or treatments that can help.
- Eat healthy foods. Eat plenty of fruits, vegetables and whole grains. Limit sugar, salt and saturated fats.
- Get regular exercise. Staying active keeps the heart healthy. But how long and hard you can exercise may depend on the stage of mitral valve regurgitation. Talk with your healthcare team about the amount and type of exercise that's best for you.
- Keep a healthy weight. Being overweight increases the risk of heart disease. Ask your healthcare professional what weight is best for you.
- Limit or do not drink alcohol. Heavy alcohol use can cause irregular heartbeats and can make your symptoms worse. Excessive alcohol use also can cause a weakened heart muscle that leads to mitral regurgitation. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
- Practice good sleep habits. Poor sleep may increase the risk of heart disease and other long-term health conditions. Adults should try to get 7 to 9 hours of sleep daily. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk with a healthcare professional about treatments that might help.
- Manage blood pressure, cholesterol and blood sugar. Ask your healthcare team how often you need to have your blood pressure, blood sugar and cholesterol levels checked.
- Find ways to help reduce emotional stress. Some tips are to get more exercise, practice mindfulness and connect with others in support groups.
If you have mitral valve regurgitation and are thinking about getting pregnant, talk with your healthcare team first. Pregnancy makes the heart work harder. How a heart with mitral valve regurgitation handles this extra work depends on the amount of regurgitation and how well the heart pumps.
Preparing for your appointment
If you think you have mitral valve regurgitation, make an appointment for a health checkup. You might be sent to a doctor trained in heart diseases, called a cardiologist. Here's some information to help you prepare for your appointment.
What you can do
- When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat or drink for a few hours before a cholesterol test.
- Write down your symptoms, including any that seem unrelated to mitral valve regurgitation. Note when they started, and what you were doing when they started.
- Write down important personal information. Include any family history of heart disease, congenital heart conditions, stroke, high blood pressure or diabetes. Also note any major stresses or recent life changes.
- Make a list of all medicines, vitamins and supplements you take. Include the dosages.
- Take someone with you, if possible. Someone who goes with you can help you remember information you're given.
- Be prepared to talk about your diet and exercise habits. If you don't already eat well and exercise, be ready to talk with your healthcare team about challenges you might face in getting started.
- Write down questions to ask your healthcare team.
For mitral valve regurgitation, some basic questions to ask a healthcare professional include:
- What is likely causing my condition?
- What are other possible causes?
- What tests do I need?
- What's the best treatment?
- What are other treatment options?
- I have other health conditions. How can I best manage them together?
- What changes do I need to make to my diet or activities?
- If I need surgery, which surgeon do you recommend for mitral valve repair?
- Is there any information that I can take with me? What websites do you recommend?
Don't hesitate to ask any other questions.
What to expect from your doctor
Your healthcare team usually asks you many questions, including:
- When did your symptoms start?
- Do you always have symptoms, or do they come and go?
- On a scale of 1 to 10, with 10 being the worst, how bad are your symptoms?
- What, if anything, makes your symptoms better?
- What, if anything, makes your symptoms worse?