Understanding and treating mitral valve disease

The human heart has four valves — mitral, tricuspid, pulmonary and aortic. These valves have flaps that open and close with each heartbeat.

The mitral valve is located between the upper and lower left chambers of the heart, the left atrium and left ventricle. Sometimes, this valve doesn't work as well as it should, leading to what's called mitral valve disease. This can happen in a couple of ways: the valve might leak, or it might become too narrow.

Let's explore what mitral valve disease is all about, including the different types, common symptoms, how it's diagnosed, and the many ways it can be treated.

What are the types of mitral valve disease?

There are two main types:

• Mitral valve regurgitation. When the mitral valve doesn’t close properly, blood can leak backward into the left atrium resulting in damage to the heart muscle. This is called regurgitation and is most commonly caused by mitral valve prolapse, where the “leaflets” of the valve move backward with heart contractions causing the leak. Two percent of the population experiences mitral valve prolapse, according to the American Heart Association.
• Mitral valve stenosis. Sometimes, the mitral valve flaps become thickened or stiff and can grow together. This fusion of the tissues results in a narrowing of the valve opening and reduces the blood flow from the left atrium to the left ventricle. As a result, the amount of oxygen in the blood traveling from the lungs is limited. Mitral valve stenosis is very rare and is almost always related to a history of rheumatic fever during childhood, which can occur after strep throat or scarlet fever.

What are the signs and symptoms? 

Some people don’t experience any symptoms related to mitral valve disease, but others do. Common symptoms include fatigue, shortness of breath, swelling in ankles and feet, or an irregular heartbeat. Additionally, your doctor may hear an abnormal heart sound (heart murmur) while listening to your heart with a stethoscope. If you or a loved one experiences any of these symptoms, see your physician.

How is mitral valve disease diagnosed?

Detection of a heart murmur by a doctor during a physical exam may lead to a referral to a cardiologist and further testing. An echocardiography (ECHO) is the most common test used to diagnose the condition, but your doctor may also order an electrocardiogram (EKG) or chest X-ray. If confirmed, more tests, such as a cardiac stress test or cardiac MRI may be ordered to help determine severity.

What are treatment options for mitral valve disease?

Not all cases of mitral valve disease require treatment, but when treatment is warranted, it can range from diet and exercise recommendations to surgery, based on condition severity. Medications don’t currently exist to treat valve disease, however there are medications that can treat its symptoms. 

In addition to medication, a treatment plan may include:

• Heart-healthy lifestyle changes: Maintaining a healthy weight, regular exercise, a low sodium, mostly plant-based diet and stress management can encourage heart health.
• Balloon valvuloplasty: This non-surgical procedure stretches the opening of the valve by inserting a balloon through a special catheter.
• MitraClip®: Used for patients who aren’t candidates for open heart surgery, the device is inserted through a catheter and used to clip the mitral valve leaflets together. Edward Hospital is one of a handful of hospitals to offer MitraClip (see photo) in the treatment of mitral valve regurgitation.
• Heart valve repair: Often performed on a minimally invasive basis, this procedure may use your own tissue to repair or remodel heart valves.
• Heart valve replacement: This surgical procedure replaces damaged valves with a new mechanism, either human, animal or artificial.