What is Mitral Valve Regurgitation (Mitral Insufficiency)?
Mitral Valve Regurgitation also known as Mitral Insufficiency is basically a leaky mitral valve. As a doctor that specializes in heart valve disease, this is the most common valve problem I see. The mitral valve stops blood flowing backwards from the main chamber of the heart and allows it to go forward to the body where it is needed. In mitral valve regurgitation the blood is allowed to flow backward. If too much blood flows backward, such as in severe mitral valve regurgitation, the body wont get the blood it needs to function and symptoms can develop.
What Causes Mitral Valve Regurgitation (Mitral Insufficiency)?
The most common cause of mitral valve regurgitation (mitral insufficiency) is mitral valve prolapse. Other causes of mitral valve regurgitation (mitral insufficiency) are an enlarged heart, calcium build up, and also coronary artery disease. See this previous post for a detailed review of mitral valve prolapse. In mitral valve prolapse the valve becomes floppy and in severe prolapse the valve allows a lot of blood to flow backward. There is a condition known as flail leaflet where the strings holding the valve snap and allow the valve to swing freely backward leading to very severe mitral valve regurgitation (severe mitral insufficiency).
How is Mitral Valve Regurgitation (Mitral Insufficiency) Graded?
The pictures shown here are from a test known as an echocardiogram, which is an ultrasound-scan of the heart and the most common method used to assess heart valves. Its important to note that this test can be variable and when important decisions need to be made regarding this, such as in severe cases of mitral valve regurgitation (mitral insufficiency), it really should be assessed by a dedicated expert. See the table for an idea of how the severity of regurgitation is determined. When more than 50% of the blood leaks backward it is in a severe category and when less then 20-30% leaks backwards it’s in a milder category.
How is Mitral Valve Regurgitation (Mitral Insufficiency) Treated?
Treatment of mitral valve regurgitation (mitral insufficiency) is very dependent on the underlying cause. Mild to moderate regurgitation typically doesn’t require any dedicated treatment. If the cause is heart failure or coronary artery disease, then initial attempts are made to treat the heart failure first, typically with medicines or sometimes procedures to restore the blood flow to the arteries. In cases of severe mitral valve regurgitation (severe mitral insufficiency) surgery may be considered to fix the valve, or consideration of one of the newer minimally invasive techniques that I will discuss in a further post.
In the case of mitral valve prolapse with mitral valve regurgitation, there is no specific treatment for the valve. There is some evidence that beta-blockers may be helpful, although larger studies are required to confirm this before it can be suggested widely. When there is severe mitral valve regurgitation, there should be consideration of fixing the valve, especially in the presence of symptoms, abnormal heart rhythm, or significant heart enlargement. In the case of moderate mitral valve regurgitation the key is to watch the valve closely over time, and monitor the size of the heart and the degree of the leakiness. Decisions regarding timing of intervention for mitral valve regurgitation (mitral insufficiency) disease are often complex and ideally should be made by dedicated specialists.
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Comments are purely for informational purposes and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Disclaimer
Renae says
June 24, 2016 at 3:35 amTHANK YOU!!! I have been scouring the internet trying to find a reputable website about Mitral Valve Prolapse/Regurgitation that is easy to understand AND thorough. This site is perfect!! I find the diagrams and charts especially useful!! Seriously, “Commonly Used Definitions for Grading the Severity of Mitral Valve Regurgitation” illustration is exactly what I’ve been trying to find!! Yes, I’ve found the same information on multiple sites. But with this I don’t have to go between my notes or try to remember where I saw what! It’s a perfect “at a glance” guide that can easily be referred back to when needed. I’ve read two other articles as well and found them just as informative and relevant to what I was looking for.
I don’t mean to sound so dramatic….I’m genuinely excited that I found this site! This topic has always been interesting to me since I was told I had a “leaky valve”. However, I recently learned that mine has gone from the mild to moderate range. I want to dig a little deeper and learn more than just general information about this condition. So again, thank you!!
Donna S. says
September 12, 2016 at 3:31 pmI recently had an echocardiogram for “unspecified heart murmur”, the heart murmur having been noticed in the past two months (as it was not noticed before) The report read as follows:
1. Overall good image quality.
2. Trace mitral regurgitation with preservation of left atrial size.
3. Mild tricuspid regurgitation.
4. Indirect evidence of left ventricular diastolic dysfunction.
5. Preserved left ventricular systolic function with an ejection fraction in the 55-60% range.
Should I be concerned over any of these stated findings?
Dr. Mustafa Ahmed says
September 13, 2016 at 1:51 amNo real cause for concern there
Demetrice Omozusi says
January 30, 2017 at 5:12 amI was informed that I may have moderate tricuspid regurgitation and pulmonary HTN pressure. I have had shortness of breath, dizziness, lightheaded. I have also read side effects to some medications. I have been in and out the ER. My EKG comes back good, my blood work comes back good and the ultrasound for blood clots in my legs comes back good and so does blood clots overrall. So how do I know it’s not the side effects to other medications?
Mary says
May 1, 2019 at 2:41 amThank you for the article. It helps me some. My father 75 years old is very I’ll. 4 weeks ago he went to his GP for SOB. 2 CT SCANS were done, a tumor was found in his right lung and a very enlarged heart. 2 weeks ago I took him to the pulmonologist and I was astonished by the decline in health. He couldn’t walk 5 steps without SOB, falling asleep sitting up. 2 days later my stepmother was unable to wake him, when he did wake he was unable to dress himself. He was admitted to ICU with CHF. He is a smoker. No alcohol. 4 days later he began A fib, A flutter and had his heart shocked twice. An end of life care specialist visited him. Told him he they were withholding food as they believed he would need to be vented and what are his wishes he is too sick to ever come off the vent and would never leave the hospital without a trach. Vents are intended for healthier people. Well, he blew them away by not only avoiding the vent but against medical orders getting out bed and walking and his O2 saturation was 99 without oxygen . From 84 O2 saturation with 100% pressure oxygen. He is home with no home oxygen required.
The A Flutter was caused by a severely leaky mitral valve. He also had a cardiac event the morning we were unable to wake him as troponin levels were elevated. They monitored every 3 hours.
My concern is that his lungs cannot anesthesia we were told. He will never be able to have surgery again. In order we were CHF needed to be treated first. If he made it home, then possibly a couple weeks later he may be strong enough to tolerate an angiogram. Once any blockage or valve issues are treated then they can look at the cancer and get a PetScan to look for spreading.
I can’t even tell you how overwhelming this all is. That he fought and came back from the brink of death. It seems the cards are stacked against him. I am concerned about the mitral valve. I know transcatheter valve replacement can be done, but I am not sure if I understand if a leaky mitral is treatable with transcatheter valve replacement.
He is thankful to have made it home and to possibly enjoy a couple family picnics this summer. We will make the most of that time.
I am really concerned with this valve and afraid it will be untreatable and ultimately prevent him from getting treated for his cancer.
Dr. Mustafa Ahmed says
May 20, 2019 at 4:35 amThere may be options such as the mitraclip and the TMVR.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.