What Is Mitral Regurgitation?

The mitral valve is one of the heart’s four valves. It has flaps (leaflets or cusps) that control the flow of blood from the left atrium to the left ventricle. If the flaps do not close tightly or the valve’s size and shape are altered, blood may leak backward. This leak is called mitral regurgitation or mitral insufficiency.

When your mitral valve leaks, your heart needs to work harder to pump blood through the valve, leading to atrial fibrillation (AFib) or heart failure. There are two types of mitral valve regurgitation:

  • Degenerative mitral regurgitation: This occurs when the mitral valve itself is dysfunctional. The flaps may droop or bulge and do not close tightly.
  • Functional mitral regurgitation: Functional mitral regurgitation happens when an issue outside of the valve (such as diseases of the left ventricle) causes the leakage. You may have normal valve flaps and still be diagnosed with functional mitral regurgitation.

Mitral Valve Regurgitation Symptoms

Mitral valve regurgitation often evolves slowly with no noticeable symptoms. As the condition progresses, you may develop symptoms including:

  • Shortness of breath: You may have trouble breathing, especially during exercise.
  • Heart palpitations: You may notice a fluttering sensation in your heart, especially when lying on your left side.
  • Swelling of hands and feet: Extremities may swell when blood flow is disturbed.
  • Fatigue: You may tire easily, especially during physical exertion.

Possible causes of mitral regurgitation include:

  • Mitral prolapse, a common heart defect in which the valve flaps bulge into the left atrium every time the heart contracts, preventing the valve from closing tightly
  • Damaged tissue cords, which anchor the flaps of the mitral heart valve
  • Rheumatic fever, a complication of strep throat
  • Endocarditis, an infection that affects the heart’s lining
  • Heart attack, which can damage the heart muscles surrounding the mitral valve
  • Cardiomyopathy, a weakened heart muscle resulting from hypertension, heart attack, viruses or inherited disease
  • Congenital heart defects, or structural heart issues present at birth

Diagnosing Mitral Regurgitation

To diagnose mitral valve regurgitation, your cardiologist will use echocardiography and cardiovascular imaging techniques including:

  • Transthoracic echocardiogram (TTE)
  • Electrocardiogram (ECG)
  • Chest X-ray
  • Cardiac magnetic resonance imaging (MRI)
  • Exercise or stress tests

Mitral Regurgitation Treatment at Penn Medicine

If your regurgitation is not causing symptoms, your cardiologist may recommend regular monitoring. If symptoms exist, medications may ease the discomfort.

Depending on the progression of your valve disease, Penn’s cardiac team may suggest repairing or replacing your valve with procedures including:

  • Mitral valve surgery, which is performed as either traditional, open-chest surgery or minimally invasive heart surgery. Whenever possible, we’ll operate on your valve robotically.
  • Transcatheter mitral valve replacement (TMVR), which is a nonsurgical option for valve replacement used if your previously replaced mitral valve is leaking.
  • MitraClip™, which is a catheter-based procedure used to repair functional mitral regurgitation, as well as degenerative regurgitation in high-risk patients.

In addition to offering traditional treatments, Penn interventional cardiologists study and test innovative transcatheter devices developed to treat mitral valves. Select patients are candidates for investigational devices and procedures through clinical trials offered at Penn.

Penn Programs & Services for Mitral Regurgitation

Doctor writing on clipboard
Heart Valve Disease

Surgeons and cardiologists use innovative catheter-based procedures and minimally invasive surgery to repair and replace heart valves.

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