What you need to know about mitral regurgitation, its diagnosis and mitral valve repair

Mitral regurgitation (or leaky mitral valve) is a condition where the mitral valve in the heart does not close properly, allowing blood from the left ventricle to flow backwards into the left atrium and effectively towards the lungs, instead of moving forward towards the body. In early stages, people can remain free of symptoms but as it is a progressive condition, it can still require regular checks for monitoring. Over time, this places strain on the heart and the lungs, leading to symptoms such as fatigue or tiredness, palpitations and shortness of breath, particularly during physical activity or when lying flat. People may notice swollen ankles or feet especially in advanced stages as complications like heart failure start to develop. 

What causes mitral regurgitation and how is it diagnosed?

Mitral regurgitation can develop gradually because of age-related valve deterioration causing damage to valve structures. It can sometimes appear suddenly due to conditions like infection (infective endocarditis) or heart attacks affecting the valve structure. It may also be linked to malformations of the valve.

Diagnosis typically begins with a clinical examination, where a doctor may detect a heart murmur. Sometimes this can be incidental i.e. although it is not the problem someone may be seeing a doctor for and it is found during a careful examination. An echocardiogram is a key test and usually the first one used to confirm the diagnosis and assess the severity of the regurgitation. Additional tests, such as ECG, chest X-ray or cardiac MRI, may also be used to evaluate the valve function and impact on heart size and heart function.

Why is early intervention important in mitral regurgitation?

Early intervention is considered essential because mitral regurgitation can progress silently. Even when symptoms are mild or absent, the heart may already be working harder to compensate for the backflow of blood. Over time, this increased workload can weaken the heart muscle and lead to heart failure or rhythm problems e.g. atrial fibrillation. Additionally, the lungs can get affected from more blood flow, which in turn increases work for the right side of the heart causing problems with its function and tricuspid valve problems.

Treating the condition when it is in the severe range, even in early stages, improves both short- and long-term outcomes, preventing complications and also has an impact on overall life-expectancy. Regular monitoring allows specialists to determine the right time for treatment, before the disease process is too advanced and complications develop.

What are the treatment options for mitral regurgitation?

Treatment depends on the severity of the condition and the patient's overall health. In mild cases without symptoms, regular monitoring and medication to control blood pressure or heart rhythm may be sufficient.

When the condition becomes more advanced (called severe category by medical professionals), interventional procedures should be considered to improve the valve function. This includes surgery, or less invasive procedures. Various treatment options are considered and the best treatment depends on who the patient requiring treatment is, i.e. age, other medical conditions etc. are considered in this decision. Broadly speaking, the following are under consideration:

• Surgical Mitral valve repair, which preserves the natural valve, is usually preferable due to various advantages over replacement. It does have a number of criteria and an experienced specialist surgeon is the best person to advise on possibility of this.
• Surgical Mitral valve replacement, using either a mechanical or biological prosthetic valve (artificial heart valve).
• Transcatheter procedures - e.g. MitraClip or other clip procedures, and some valve replacements. These are relatively new procedures compared to surgery and are increasingly becoming good options. They have a number of criteria requiring detailed assessment and also longer-term results are currently not known. Hence these procedures are usually for patients who are assessed to be at high-risk for open-heart surgery or for patients thought to have difficult recovery from surgery.

How does surgical mitral valve repair help?

Mitral valve repair by surgery is widely considered the gold standard for treating mitral regurgitation when possible. Rather than replacing the valve, the surgeon restores its normal function by reshaping, reinforcing or adjusting the valve leaflets or supporting structures.

Repair offers several advantages, including better preservation of heart function, reduced risk of complications and, in most cases, no need for lifelong anticoagulant medication (blood thinners). Advances in surgical techniques have made repair safer and more accessible. Additionally, minimally invasive surgery approaches, can help patients recover faster with smaller incisions with less restrictions during postoperative recovery period and has other advantages e.g. less bleeding and overall shorter stay in hospital.

Living with mitral regurgitation: what should patients expect?

With timely diagnosis and appropriate treatment, whether surgery or less invasive cardiology procedures, most patients can expect to return to normal lifestyle fairly quickly and also have a good long-term outlook. Regular follow-ups with an experienced cardiologist, a healthy lifestyle and prompt attention to new symptoms are key to long-term success.