How is mitral regurgitation treated?

Mitral regurgitation is a condition where the leaflets of the mitral valve do not completely seal when closed or are perforated (infection) resulting in blood returning to the left atrium. There is a classification of mitral regurgitation from mild, moderate, to severe. People with mild disease even if they do not have symptoms should be followed up by their doctor. A echocardiography which documents the function of the mitral valve should be performed regularly to assess the progress. Medication can be given to reduce the symptoms but they do not have any effect on the mitral valve leakage. Usually diuretics to reduce accumulation of fluid to the lungs caused by mitral regurgitation or blood pressure lowering drugs are prescribed. In the cases where mitral regurgitation becomes moderate to severe or severe then mitral valve surgery is recommended. The timing for a surgery is always crucial for the outcome. If mitral valve disease is left untreated too long the heart may become damaged and the surgery is not going to give the full benefit to the patient. The surgery options are mitral valve repair or replacement. With the mitral valve repair the valve is preserved and is repaired most commonly by cutting excessive tissue from a prolapsing leaflet, tightening the annulus surrounding the valve by the use of a ring. The replacement valves are of two types: mechanical and biological. Mechanical are made from artificial parts to resemble the function of the mitral valve and the biological ones are usually taken from pigs or cows. The surgery is an open-heart one under general anesthesia requiring the use of a heart-lung machine which replaces the function of the heart and the lungs while the surgeon fixes the valve. Traditionally it was done by cutting the whole breastbone (sternum). Recently there is an option for minimally-invasive operations which by half-cutting the sternum or using thoracic access may reduce the pain from incision, the blood loss and the length of stay to the hospital with the patients having a better cosmetic result.

The mitral valve is located between the left upper and left lower chamber of the heart. Mitral valve regurgitation, or leaking, may be the result of a condition called mitral valve prolapse, in which the valve leaflets and the fibers, or cords, that support them become floppy and elongated. Mitral valve prolapse does not always lead to regurgitation. In fact, many people who have mitral valve prolapse never develop severe leaking of the mitral valve. Mitral regurgitation can also occur if your left ventricle gets enlarged due to heart disease in which the ring of tissue that encircles the opening of the mitral valve (called the annulus) becomes enlarged and the leaflets cannot reach each other.  Severe mitral regurgitation over time can lead to failure of the left ventricle of the heart.

Depending on the severity of your heart valve disease, your cardiologist may recommend the following treatments:

• Medications. No medications have been proven to help the flaps of the mitral valve close properly. However, your doctor may recommend medications to help reduce the symptoms of mitral regurgitation. If you are diagnosed with mild (grade 1) or moderate (grade 2) mitral regurgitation, your doctor may decide the best care approach is to monitor your condition and prescribe drugs to help treat its symptoms. These medications may include the following: diuretics (water pills), blood pressure medicines and antibiotics to prevent or treat infection of the heart valve.

• Surgical treatment. If you are diagnosed with moderate to severe (grade 3) or severe (grade 4) mitral regurgitation, your doctor may recommend mitral valve repair or replacement.