Mitral valve regurgitation (MVR)

2021-08-01 05:05 PM

When the mitral valve is not working properly, blood cannot move through the heart or to the rest of the body as efficiently. Mitral regurgitation can cause fatigue and shortness of breath.

Define

Mitral regurgitation occurs when the mitral valve does not close tightly, allowing blood to flow backward. The mitral valve is located between the two left chambers of the heart, allowing blood to flow through the heart valve when the heart rhythm is normal. Mitral regurgitation is also known as mitral insufficiency or mitral valve abnormality.

When the mitral valve is not working properly, blood cannot move through the heart or to the rest of the body as efficiently. Mitral regurgitation can cause fatigue and shortness of breath.
 
Treatment for mitral regurgitation depends on the severity of the condition, its likelihood of getting worse, and signs and symptoms. For mild cases, treatment may not be necessary. Heart surgery may be needed to repair or replace the valve in many severe cases. If left untreated, mitral regurgitation can cause heart failure or serious heart rhythm problems (arrhythmias).

Symptoms

The signs and symptoms of mitral regurgitation depend on its severity and progression. Symptoms of mitral regurgitation include:

Heart murmur.

Shortness of breath, especially with exertion or when lying down.

Fatigue, especially during periods of increased activity.

Dizziness.

Cough, especially at night or when lying down.

Tachycardia - feeling of a fast fluttering heartbeat.

Swollen feet or ankles.

Urinating too much.

Mitral regurgitation is usually mild and progresses slowly. It is possible to be asymptomatic for decades and not know there is a problem.

Mitral regurgitation is usually first suspected when a doctor hears a new heart murmur. Sometimes, however, the problem develops quickly, and can experience a sudden onset of severe signs and symptoms.

If signs and symptoms develop that indicate mitral regurgitation or another problem with the heart, see your doctor right away. Sometimes, the first signs of mitral regurgitation are actually its complications, including heart failure. Heart failure is a condition in which the heart cannot pump enough blood to the rest of the body, causing shortness of breath, fluid buildup, and fatigue. There are several causes of this, and mitral regurgitation is just one of them.

However, mitral valve regurgitation is often detected earlier, during routine examination when the doctor listens to the heart. An open mitral valve can cause an abnormal heart sound (heart murmur).

Mild mitral regurgitation may not progress and never pose a serious threat to health. But when severe, mitral valve prolapse can cause heart complications and may require surgery to repair.

Causes

The heart is the pump of the circulatory system, which has four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.

Blood flows through the chambers of the heart with the help of four heart valves. The valves open and close, allowing blood to flow through the heart in only one direction. The mitral valve, located between the two left chambers of the heart, has three triangular leaflets.

Heart valve open. The leaflets of the mitral valve open when the left atrium contracts, pushing blood through the leaflets and into the left ventricle. When the left atrium relaxes between contractions, the valve closes, preventing blood that has just been brought into the left ventricle from flowing backward, in the wrong direction.

During operation, the heart valves open and close completely. In mitral regurgitation, the mitral valve does not close tightly. So, with each heartbeat, some blood from the left ventricle flows back into the left atrium, instead of into the aorta.

Mitral regurgitation can be caused by many problems, including:

Mitral valve prolapse

Prolapse is a condition in which the leaflets and cords that support the mitral valves weaken. As a result, each time the left ventricle contracts, the leaflets bulge (prolapse) up into the left atrium. However, mitral valve prolapse is common and most people who have it never develop severe regurgitation.

Damaged ligaments

Mitral regurgitation can damage the ligaments that anchor the mitral valve to the heart wall. Over time, the ligaments can stretch or be destroyed, especially in people with mitral valve prolapse. Ligament ruptures can cause significant valve regurgitation and may require cardiac surgical repair.

Rheumatic fever

Rheumatic fever - a complication of untreated pharyngitis and a once-common disease - can damage the mitral valve, leading to later mitral regurgitation. Rheumatic fever can damage the mitral valves in two ways. Infection can cause the valve's leaves to thicken, limiting the valve's ability to function. This narrows the valve, a problem known as mitral stenosis. Infection can also cause scarring of the mitral valve leaflet, leading to regurgitation. People with rheumatic fever, which is also common in countries where antibiotic use is uncommon, can have both mitral stenosis and mitral regurgitation.

Endocarditis

The mitral valve can be damaged by endocarditis, an infection of the lining (endocardium) of the heart that can involve the heart valves.

Valve failure

The mitral valve opens and closes tens of thousands of times per day. Wear and tear are sometimes related to age, in the causes of mitral regurgitation.

Heart attack

A heart attack can damage the heart muscle that supports the mitral valve, affecting the valve's function. In fact, if the damage is large enough, a heart attack can cause sudden severe mitral regurgitation and regurgitation. This sudden opening is sometimes called acute mitral regurgitation.

Untreated high blood pressure

Over time, high blood pressure can make the heart work harder, and gradually the heart's ventricles can dilate. This can then stretch the tissue around the mitral valve, which can lead to regurgitation.

Congenital heart defects

Some babies are born with defects in the heart, including damaged heart valves.

Severe mitral regurgitation - a possible cause of heart failure. When the left ventricle contracts in mitral regurgitation, some blood flows back into the left atrium instead of into the aorta. As a result, blood flow to the rest of the body is reduced. In response, the left ventricle can dilate so it can pump more blood with each heartbeat. At first, adapting to this will help the heartbeat with more force. But eventually, this change can cause heart failure and abnormal heart rhythms, such as atrial fibrillation.

Risk factors

Several factors can increase the risk of mitral regurgitation, including:

History of mitral valve prolapse or mitral stenosis. However, having a problem or not, does not mean that you will develop mitral regurgitation. In fact, most people with mitral valve prolapse never develop severe regurgitation.

A heart attack. A heart attack can damage the heart, affecting the function of the mitral valve.

Use certain medications. People taking ergotamine and similar medications for migraines and those already taking pergolide (now removed from the market) have an increased risk of mitral regurgitation. Similar problems were reported with appetite suppressant fenfluramine and dexfenfluramine no longer being sold.

Infections such as endocarditis or rheumatic fever. Infection can damage the mitral valve.

Congenital heart disease. Some people are born with an abnormal mitral valve, which is prone to the cleft. Often babies born with heart defects can have more than one problem, such as a hole in the upper chambers of the heart (atrial septal defect) and an abnormal mitral valve.

Age. From middle age, many people have mitral regurgitation caused by the natural deterioration of the valve. However, mitral regurgitation causes symptoms in only a small percentage of older adults.

Complications

When mild, mitral regurgitation can never cause problems. But when it's severe, mitral regurgitation can lead to complications:

Heart failure. In heart failure, the heart cannot pump enough blood to meet the body's needs. Severe mitral regurgitation, secondary flow on the heart due to the need for extra blood pumping. The left ventricle is larger, and if left untreated, weakens. This can cause heart failure. Fluid and pressure build up in the lungs as a result of mitral regurgitation and can eventually place stress on the right side of the heart, leading to swollen ankles (edema). People who experience shortness of breath and wake up at night may feel short of breath.

Atrial flutter. This is an irregular heartbeat in which the upper chambers of the heart (the atria) vibrate chaotically and rapidly. Atrial fibrillation can cause blood clots. Blood clots can reach the brain causing a stroke. Other abnormal heart rhythms (arrhythmias) can also occur in people with mitral regurgitation.

Endocarditis. Endocarditis is an infection of the endocardium of the heart. Usually, the disease involves one of the heart valves, especially if it is already damaged. If the mitral valve is damaged, it is more susceptible to infection than a healthy valve. It is possible to develop endocarditis when bacteria from another part of the body spread through the bloodstream and into the heart. Doctors recommend that some people with mitral valve prolapse take antibiotics before certain dental procedures or medical procedures to prevent endocarditis, but antibiotics are no longer considered necessary in many cases. in case of regurgitation or mitral valve prolapse.

Pulmonary arterial hypertension. If you have mitral regurgitation for many years and are left untreated, or treated improperly, you may develop pulmonary hypertension. Pulmonary hypertension is a type of high blood pressure that affects only the arteries in the lungs. It is a serious disease that begins when the small arteries in the lungs become narrowed or blocked. This increases the resistance to the flow of blood in the lungs, thereby increasing the pressure in the pulmonary arteries.

Tests and diagnostics

If you have signs and symptoms of mitral regurgitation, some diagnostic tests may be needed. But your doctor will first ask about your general health, including your symptoms, previous tests, and history of heart disease in your family.

Next, the doctor performs a physical examination. Listen to heart sounds. Mitral regurgitation often presents with a heart murmur. The murmur is the sound of blood being pushed back through the mitral valve.

With this information, the doctor decides on tests that can make a diagnosis and develop a treatment plan. You may be referred to a cardiologist - a doctor who specializes in studying the heart and its function. Common tests and procedures used to diagnose heart valve problems include:

Echocardiography. This test uses sound waves to create images of the heart. In an echocardiogram, sound waves are directed at the heart from a wand-like device (transducer). An echocardiogram helps the doctor get a close look at how the mitral valve is working.

X-ray. With a chest X-ray, your doctor can see the size and shape of your heart to determine if your left ventricle is dilated. An X-ray also allows the doctor to evaluate the lungs. Mitral valve regurgitation can lead to pulmonary edema, which is visible on radiographs.

Electrocardiogram (ECG). In this test, electrodes attached to (electrical) wires are attached to the skin to measure the electrical impulses emitted by the heart. The recorded pulse is a wave displayed on a screen or printed on paper. ECG provides information about heart rate and indirectly heart size. With mitral regurgitation, the left ventricle may dilate and there may be an irregular heartbeat (arrhythmia).

Holter. The Holter monitor is a portable device that carries continuous ECG recording, usually 24 to 72 hours. Holter monitoring is used to continuously detect heart rhythm abnormalities that may be associated with mitral regurgitation.

Transesophageal echocardiography. This type of echocardiogram allows a closer look, even at the mitral valves. The esophagus, the tube that runs from the throat to the stomach, is located close to the heart. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down the esophagus. Because the esophagus is so close to the mitral valve, the transducer provides a clearer picture of the valve's structure and blood flow through it.

Stress test. Various exercise tests can help detect heart activity and check the exercise (exercise) response.

Cardiac catheterization. In this procedure, the doctor inserts a small tube (catheter) through a blood vessel in the arm or groin into the heart. This catheter is used to deliver dye into the heart's chambers and blood vessels. The dye, which appears on the X-ray image as it moves through the heart, gives doctors detailed information about the heart and heart valves. Some catheters used in cardiac catheterization have miniature devices (sensors) that can measure the pressure in the heart chambers, such as the left ventricle.

Treatments and drugs

Treatment for mitral regurgitation depends on the severity of the condition, and if it gets worse. The goal of treatment is to improve heart function while minimizing signs and symptoms and avoiding future complications.

Some people, especially those with mild clefts, do not need treatment. However, even in the absence of signs and symptoms of mitral regurgitation, monitoring may be required. A frequent evaluation may be required, with the frequency depending on the amount of regurgitation.

Medicine. Medicines cannot correct the deformity of the mitral valve. But medications like diuretics are available to reduce fluid buildup in the lungs or legs, which can accompany mitral regurgitation. High blood pressure makes mitral regurgitation worse, so if you have high blood pressure, your doctor may prescribe medication to help lower it. A low-salt diet will help prevent fluid buildup and help control blood pressure.

Surgery. The mitral valve may need to be surgically repaired or replaced. If you feel good, you may need open-heart surgery. However, it is possible to have mitral regurgitation and not be able to have surgery. This is because some problems resist the possibility of surgery.

However, if you wait too long for surgery, the heart can become irreparably damaged or become weakened and surgery will not be able to help. That's why it's important to closely monitor mitral regurgitation and have surgery if your doctor feels it will help avoid future problems.

Discuss the risks and benefits of surgery with your doctor.

Surgical options include:

Valve repair. Valve repair is a valve-sparing surgery. For most people with mitral valve prolapse, this is the correct surgical treatment.

The mitral valve consists of two triangular flaps called leaflets. The leaflets of the mitral valve connect to the myocardium through the annulus. Surgeons may change the original valve (valvuloplasty) to eliminate backflow. The surgeon can also repair it by reconnecting the leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes valve repair includes tightening or replacing the valve ring. This is called an annuloplasty. It is important to have a surgeon who has experience performing mitral valve repair.

Replace valve. Valve replacement is performed when a repair is not possible. In valve replacement surgery, the damaged mitral valve is replaced with an artificial (false) valve. Two types of prosthetic valves are mechanical and biological.

The mechanical valve is made of metal, which can last a long time. However, if you have a mechanical valve, you must use anticoagulants, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and falls freely, it can travel to the brain and cause a stroke.

Biological valves are made from animal tissue such as a pig's heart valve. These valves are called bioprostheses. It can fibrosis over time and replace as needed. However, one advantage of biovalves is that there is no need for long-term anticoagulation.

Mitral valve repair or replacement requires open-heart surgery under general anesthesia. With traditional open-heart surgery, a cut to the length of the sternum is performed and the heart is exposed and connected to a heart-lung machine, for breathing and blood circulation function during surgery. The surgeon then replaces or repairs the valve. Then one or more days are spent in the intensive care unit, where cardiac function and general recovery are closely monitored.

The mitral valve prolapse can be removed surgically, but some people may continue to have the regurgitation. Talk to your doctor about what kind of follow-up you need after surgery and let your doctor know if you develop new or worsening signs and symptoms after treatment.

Less invasive techniques. Doctors are developing less invasive techniques to treat valve disorders, such as mitral valve repair or replacement using cardiac catheterization.

Some surgeons now repair the mitral valve through small cuts in the chest (minimally invasive heart surgery), often with the use of a robot to help repair the valve. People who have had minimally invasive cardiac surgery often have a shorter recovery time and leave the hospital earlier. These techniques are not for everyone, talk to your surgeon to see if this surgery might be appropriate.

Lifestyle and remedies

To improve your quality of life if you have mitral regurgitation, your doctor may recommend:

Check blood pressure regularly. Controlling high blood pressure is important if mitral regurgitation is present.

Eat a heart-healthy diet. Food does not directly affect mitral regurgitation. However, developing coronary artery disease - blockage of the arteries that feed the heart muscle - can lead to heart attacks with further weakening of the heart muscle. To follow a heart-healthy diet, eat low-fat foods, and check your cholesterol levels regularly. In addition, your doctor may recommend limiting your salt intake. If you have questions about your diet, ask to speak with a dietitian.

Maintain a healthy weight. Being overweight can make breathing difficult and can complicate heart surgery if it is needed. Keep the weight within a range recommended by your doctor.

Cut down on caffeine. An irregular heartbeat (arrhythmia) can occur in people with mitral valve prolapse. Arrhythmias may worsen with coffee. Ask your doctor about drinking caffeinated beverages like coffee and soft drinks.

Cut down on alcohol. Heavy drinking can cause arrhythmias and can make symptoms worse. Drinking too much alcohol can also cause cardiomyopathy, a condition of the weakened heart muscle that often leads to mitral regurgitation. If you have mitral regurgitation, ask your doctor about the effects of alcohol.

Do exercise. Physical activity is suitable for the body and can also help with faster recovery if heart surgery is needed. Doctors often provide instructions for exercise programs. Do not discontinue the procedure if a diagnosis of mitral regurgitation has been received. If you find you can't do things because of mitral regurgitation, talk to your doctor.

See your doctor regularly. Establish a regular evaluation schedule with your cardiologist.

If you are a woman with mitral regurgitation, discuss family planning with your doctor before becoming pregnant, because the heart works harder during pregnancy. The heart with mitral regurgitation tolerates this extra work depending on how well the regurgitation is and how well the heart pumps blood. If pregnant, cardiologists and obstetricians need to evaluate pregnancy, delivery, and postpartum.

Prevention

Because rheumatic fever is a risk factor for developing mitral regurgitation, if your sore throat is severe, see your doctor. If left untreated, strep throat can lead to rheumatic fever. Fortunately, sore throats are easily treated with antibiotics.

If you have high blood pressure, it's important to make sure it's well-controlled to prevent mitral regurgitation.

If the heart valve is abnormal, such as mitral valve prolapse, it is important to seek medical attention if you have a fever or signs or symptoms of an infection of the heart tissue (endocarditis).

If mitral regurgitation is present, talk to your doctor about the frequency of follow-up checkups and how often your doctor checks the number of regurgitation through regular exams and ultrasound follow-up as needed.