Mitral Valve Disease

The mitral valve is the gateway between the lungs and the heart. Oxygenated blood from the lungs enters the heart and flows through the mitral valve into the heart’s pumping chamber (left ventricle). The left ventricle pumps blood out to the rest of the body through the aorta. When the left ventricle contracts, the mitral valve’s two leaflets close to prevent blood from flowing backward.

The mitral valve also has a series of supporting fibers (chords) and muscles attached to the leaflets. These structures prevent the leaflets from bulging back into the atrium (prolapsing).

But if the mitral valve leaks or tightens up, blood can back up into the lungs. The two main types of mitral valve disease are:

• Mitral valve regurgitation: This occurs when the leaflets of the valve do not close tightly and blood flows back into the left atrium. Approximately 90% of mitral valve problems are due to regurgitation.
• Mitral valve stenosis: This occurs when the leaflets become thick and the valve narrows, reducing blood flow.

Regurgitation of the mitral valve is caused by:

• Degenerative mitral valve disease: This is also called mitral valve prolapse. It occurs when the chords stretch and the valve bulges back into the atrium. When this happens, the leaflets cannot close properly. The chords can also break, leading to mitral valve flail, which usually causes a severe leak. Prolapse is associated with some inherited conditions. Males and people with high blood pressure are also at greater risk of mitral valve prolapse.  
• Secondary mitral valve disease: Mitral valve conditions can be caused by other heart conditions, such as cardiomyopathy, that cause the left ventricle to dilate (stretch out). This dilation can pull the valve apart, causing it to leak.

Stenosis of the mitral valve is most frequently caused by rheumatic fever or a buildup of calcium on the valve. These conditions lead to scarring of the mitral valve leaflets.

Mitral valve disease often progresses gradually and may be undetected for years. As the disease advances you may notice:

• Dizziness or lightheadedness
• Fatigue
• Irregular heartbeat
• Shortness of breath

Rarely, sudden mitral valve regurgitation may occur due to a heart infection or tearing of the fibers (chords) or muscles that support the mitral valve. This condition requires emergency care and usually replacement of the mitral valve.

Mitral valve disease can cause other heart and lung conditions such as:

• Atrial fibrillation (irregular heartbeat)
• Cardiomyopathy (heart muscle disease)
• Heart failure
• Pulmonary hypertension (increased blood pressure in the lungs)
• Tricuspid valve disease

The first indication of mitral valve disease is often a murmur your doctor hears when listening to your heart. A murmur is an abnormal whooshing sound of blood flowing through the damaged valve.

To confirm the diagnosis, your doctor will order an echocardiogram of your heart. This test uses ultrasound waves that show the motion of your heart and valves. Echocardiograms can be done through the chest (transthoracic) or through the throat (transesophageal). A transesophageal echocardiogram (TEE) is often the test of choice because it produces clearer images of your heart.

Your doctor may order other tests to determine the right treatment approach:

• Cardiac catheterization, where a catheter (thin tube) is inserted into a blood vessel in your groin, neck or arm and threaded to your heart. This technique can be used to diagnose and treat heart conditions. In mitral valve disease, TEE is used during cardiac catherization to get a closer look at the valve and assess valve function.
• CT scan, which is type of X-ray. At Frankel Cardiovascular Center, our imaging specialists use a unique protocol for performing a cardiac CT scan. It allows us to collect images through the entire heartbeat. A CT scan is often used to determine the most appropriate treatment option, such as a transcatheter or minimally invasive surgical approach.  

Within the Comprehensive Heart Valve Program, our team of cardiologists, surgeons and other specialists are skilled in a wide range of techniques. Their diverse expertise allows us to develop individualized treatment plans for each patient.

Some of the treatments we offer include:

• Nonsurgical treatment with medications, lifestyle changes and monitoring. This approach is often used for patients with mitral valve conditions that are caused by other heart problems such as heart failure.
• Transcatheter procedures that use small tubes (catheters) to repair or replace mitral valves. These treatments are available to patients who are not candidates for minimally invasive or open-heart surgery.
• Minimally invasive surgery, which the surgeon performs through an incision between the ribs.
• Open-heart surgery, which involves opening the chest cavity. In patients with severe mitral valve prolapse, open-heart surgery is the treatment of choice and yields better long-term outcomes.

Explore all the procedures we offer for mitral valve disease repair and treatment.