Mitral Regurgitation: Symptoms, Risks, and Treatment Options
February 1, 2025

What is Mitral Regurgitation?
Mitral valve regurgitation (MR), or mitral valve insufficiency, happens when the mitral valve doesn’t close correctly, causing blood to flow backward into the left atrium rather than forward into the left ventricle as it should. This condition is the most common type of heart valve disease, particularly affecting individuals over the age of 65.
The mitral valve, situated between the left atrium and left ventricle, plays a crucial role in ensuring one-way blood flow during heartbeats. When it starts to leak, the heart has to exert more effort to pump blood effectively. Over time, this added strain can lead to symptoms and complications, such as fatigue or fluid buildup in the lungs. While minor leaks may not produce noticeable symptoms, severe regurgitation can greatly affect heart function.
Symptoms of Mitral Valve Regurgitation
Mitral valve regurgitation (MR) typically develops gradually, and many people may not notice any symptoms for years, particularly in mild cases. However, as the condition worsens or becomes more severe, it can affect heart function and lead to noticeable symptoms. These symptoms may appear slowly or suddenly, depending on the severity and the underlying cause.
Common Symptoms of Mitral Valve Regurgitation:
- Shortness of Breath (Dyspnea): Experiencing difficulty breathing, especially during physical activity, while resting, lying down, or sleeping.
- Fatigue: Feeling excessively tired, particularly after exertion.
- Heart Palpitations: Experiencing sensations of fluttering, pounding, or irregular heartbeats, often more pronounced when lying on the left side.
- Swelling (Edema): Noticing swelling in the feet, hands, or ankles due to disrupted blood flow.
- Coughing: Having a persistent cough, is sometimes linked to fluid accumulation.
- Chest Pain: Experiencing atypical chest discomfort that isn’t always related to physical activity.
- Dizziness or Presyncope: Feeling faint without actually losing consciousness.
In rare instances, MR can occur suddenly, resulting in acute mitral valve regurgitation. This situation is a medical emergency and may present with:
- A feeling of suffocation
- Difficulty breathing when lying flat
- Chest tightness
- Low oxygen levels (which can be measured with a pulse oximeter)
Causes of Mitral Valve Regurgitation
Primary MR: This type arises from direct issues with the mitral valve itself. Direct valve problems such as mitral valve prolapse (which is most common in developed countries), rheumatic heart disease (prevalent worldwide), endocarditis, congenital defects, or connective tissue disorders.
Secondary MR: This type is caused by issues outside the valve, including conditions that impact the heart muscle or its structure: Problems external to the valve, like ischemic cardiomyopathy, atrial fibrillation, or cardiomyopathy.
Treatment
Treatment for mitral valve regurgitation (MR) depends on the degree and type of the condition, as well as the patient’s general health. Patients with mild to moderate MR can be prescribed ACE inhibitors, beta-blockers, diuretics, or anticoagulants to reduce symptoms, decrease the heart’s workload, and avoid complications such as atrial fibrillation or blood clots. These must be followed up by regular echocardiograms to monitor the disease and help with treatment decisions.
Surgical or interventional therapy may be necessary when MR is severe or symptomatic. The preferred treatment is mitral valve repair, either open-heart surgery or minimally invasive techniques. If valve replacement is not an option, valve replacement with either mechanical or bioprosthetic valves is performed. Open-heart surgery or transcatheter mitral valve replacement (TMVR) is used. Other procedures, including the Maze procedure, can be used in conjunction with repair or replacement to minimize the likelihood of developing atrial fibrillation.
Acute MR calls for urgent treatment, and surgery may be suggested for severe MR before pregnancy to avoid complications. Early and individualized intervention leads to improved outcomes, avoids heart failure, and enhances the quality of life.
Risks and Complications
- Atrial fibrillation (AFib): It is a medical condition where the heartbeat is irregular and increases a person’s risk for stroke.
- Heart failure: The heart cannot pump enough blood to every component of the body in this situation.
- Pulmonary hypertension: High blood pressure is present in the lungs’ arteries during this medical condition.
- Sudden cardiac arrest: A rare but dangerous condition
- Modifiable: Untreated strep infections, IV drug use, or delayed treatment for contributing health conditions.
- Non-modifiable: Genetic predisposition and congenital factors.
Mitral Valve Regurgitation Life Expectancy
The life expectancy of individuals with mitral valve regurgitation (MR) varies based on the severity of the condition and whether surgical intervention is performed.
- Mild MR: In mild cases, life expectancy is generally not affected.
- Severe MR without surgery: For individuals with severe MR who do not undergo surgery, the prognosis is poor. They face a 20% risk of death within the first year and a 50% chance of dying within five years.
- Severe MR with surgery: Surgical intervention, such as mitral valve repair (MVr), can significantly improve survival rates. MVr is the preferred treatment for severe MR and can restore life expectancy to levels typical of the general population.
Factors influencing life expectancy:
- Leak severity: The more severe the valve leak, the higher the risk of death.
- Age: Older individuals have a higher likelihood of not surviving beyond one year after diagnosis.
- Treatment: Repairing the mitral valve is linked to better survival outcomes compared to valve replacement.
Conclusion
The severity of the condition and the patient’s general health dictate which treatment option is most effective in managing mitral valve regurgitation. Early diagnosis and timely intervention through medication, minimally invasive procedures, or surgery prevent complications and improve quality of life. It is important to work closely with healthcare providers to achieve the best outcomes and maintain heart health over time.