Mitral Valve Disease

There are three types of mitral valve disease: mitral valve regurgitation, mitral valve stenosis, and mitral valve prolapse.

The mitral valve controls blood flow between the upper and lower chambers of the left side of the heart. The upper chamber is called the left atrium. The lower chamber is called the left ventricle. The mitral valve allows blood to flow from the left atrium into the left ventricle, but not back the other way. The heart also has a right atrium and ventricle, separated by the tricuspid valve.

With each heartbeat, the atria contract and push blood into the ventricles. The flaps of the mitral and tricuspid valves open to let blood through. Then, the ventricles contract to pump the blood out of the heart. When the ventricles contract, the flaps of the mitral and tricuspid valves close. They form a tight seal that prevents blood from flowing back into the atria.

Mitral Valve Disease Sign & Symptoms

The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope.  However, many people have heart murmurs without having heart valve disease or any other heart problems. Others may have heart murmurs due to heart valve disease, but have no other signs or symptoms. Heart valve disease often worsens over time, so signs and symptoms may occur years after a heart murmur is first heard. Many people who have heart valve disease don't have any symptoms until they're middle-aged or older.

Heart valve disease can cause chest pain that may happen only when you exert yourself. You also may notice a fluttering, racing, or irregular heartbeat. Some types of heart valve disease, such as mitral valve stenosis, can cause dizziness or fainting. Other common signs and symptoms of heart valve disease relate to heart failure, which heart valve disease can cause. These signs and symptoms include:

  • Unusual fatigue (tiredness)
  • Shortness of breath, especially when you exert yourself or when you're lying down
  • Swelling in your ankles, feet, legs, abdomen, and veins in the neck

Regurgitation, or backflow, occurs if a valve doesn't close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or into an artery.

Backflow is often due to prolapse. "Prolapse" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve. Mitral valve prolapse (MVP) affects people of all ages and both sexes. Mitral valve prolapse that causes complications or severe symptoms most often occurs in men older than 50.

Stenosis occurs if the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening. As a result, not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.

Risks and Causes of Mitral Valve Disease

A healthy diet, physical activity, other lifestyle changes, and medicines aimed at preventing a heart attack, high blood pressure, or heart failure also may help prevent heart valve disease.

If you've had previous heart valve disease and now have a man-made valve, you're at risk for a heart infection called infective endocarditis. Infective endocarditis is an infection of the inner lining of your heart chambers and valves. One of the most common causes of infective endocarditis is poor dental hygiene  because gum infections and tooth decay can increase your risk of getting the infection.

To prevent infective endocarditis, floss and brush your teeth and regularly see a dentist. Let your doctors and dentists know if you have a man-made valve or if you've had infective endocarditis before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.

Diagnosing Mitral Valve Disease

Your primary care doctor may detect a heart murmur or other signs of heart valve disease. However, a cardiologist usually will diagnose the condition. A cardiologist is a doctor who specializes in diagnosing and treating heart problems. To diagnose heart valve disease, your doctor will ask about your signs and symptoms. He or she also will do a physical exam and look at the results from tests and procedures.

Echocardiography (echo) is the main test for diagnosing heart valve disease. But an EKG (electrocardiogram) or chest x ray commonly is used to reveal certain signs of the condition. If these signs are present, echo usually is done to confirm the diagnosis.

Your doctor also may recommend other tests and procedures if you're diagnosed with heart valve disease. For example, you may have cardiac catheterization, stress testing, or cardiac MRI (magnetic resonance imaging). These tests and procedures help your doctor assess how severe your condition is so he or she can plan your treatment.

Treating Mitral Valve Disease

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.

The goals of treating heart valve disease might include:

  • Preventing, treating, or relieving the symptoms of other related heart conditions.
  • Protecting heart valves from further damage.
  • Repairing or replacing faulty valves when they cause severe symptoms or become life threatening. Replacement valves can be man-made or biological.

To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.

A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

Your doctor may ask you to limit physical activities that make you short of breath and tired. He or she also may ask that you limit competitive athletic activity, even if the activity doesn't leave you unusually short of breath or tired.

Your doctor may prescribe medicines to:

  • Treat heart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.
  • Lower high blood pressure or high blood cholesterol.
  • Treat coronary heart disease. Coronary heart disease medicines can reduce your heart's workload and relieve symptoms.
  • Prevent arrhythmias (irregular heartbeats).
  • Thin the blood and prevent clots (if you have a man-made replacement valve). These medicines also are prescribed for mitral stenosis or other valve defects that raise the risk of blood clots.

Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn't causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.

Having heart valve repair or replacement depends on many factors, including:

  • The severity of your valve disease.
  • Your age and general health.
  • Whether you need heart surgery for other conditions, such as bypass surgery. Bypass surgery and valve surgery can be done at the same time.

When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of infective endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.

However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired, but aortic and pulmonary valves often have to be replaced.

Heart Valve Repair

Heart surgeons can repair heart valves by:

  • Separating fused valve flaps
  • Removing or reshaping tissue so the valve can close tighter
  • Adding tissue to patch holes or tears or to increase the support at the base of the valve

Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients.

Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure for doing it.

Balloon Valvuloplasty

Heart valves that don't fully open (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloon valvotomy.

Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve.

Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. Thus, for these people, balloon valvuloplasty often is preferred over surgical repair or replacement.

Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.

Replacing Heart Valves

Sometimes heart valves can't be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve.

Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won't need medicines to stop your body from rejecting the valve.

Man-made valves last longer than biological valves and usually don't have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15 years or longer.

Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of infective endocarditis.

You and your doctor will decide together whether you should have a man-made or biological replacement valve.

If you're a woman of childbearing age or if you're athletic, you may prefer a biological valve so you don't have to take blood-thinning medicines. If you're elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.

Other Approaches for Repairing and Replacing Heart Valves

Some newer forms of heart valve repair and replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery usually are 3–5 days, compared with 5-day stays for traditional heart valve surgery.

New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2–4 weeks versus 6–8 weeks for traditional surgery.

Some cardiologists and surgeons are exploring catheter procedures that involve threading clips or other devices through blood vessels to faulty heart valves. The clips or devices are used to reshape the valves and stop the backflow of blood.

People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery. Researchers are still studying this treatment method.

Why Choose Aurora for Mitral Valve Disease Treatment?

Aurora uses a multidisciplinary approach to treating mitral valve disorders. At Aurora Healthcare you have access to cutting edge treatment options, including investigational procedures. St. Luke’s Medical Center was named by US New and Reports for excellent Cardiac Care in 2012-2013 and 2013-2014. 

Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.