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Mitral Regurgitation: Causes, Symptoms & Treatment

Mitral regurgitation is a heart condition in which the mitral valve does not close properly, causing blood to flow back into the left atrium. It can place a long-term strain on the heart.

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Things worth knowing about "Mitral Regurgitation"

Mitral regurgitation is a heart condition in which the mitral valve does not close properly, causing blood to flow back into the left atrium. It can place a long-term strain on the heart.

What is Mitral Regurgitation?

Mitral regurgitation (also called mitral valve regurgitation or mitral valve insufficiency) is one of the most common heart valve diseases. It occurs when the mitral valve -- located between the left atrium and the left ventricle -- fails to close completely. With each heartbeat, a portion of blood leaks backward into the left atrium instead of being pumped forward into the aorta. Over time, this places significant strain on the heart and can lead to heart failure if left untreated.

Causes

Mitral regurgitation can be classified as primary (organic) or secondary (functional), depending on whether the valve itself or the surrounding heart muscle is affected:

Mitral valve prolapse: The most common cause in Western countries. One or both leaflets of the valve bulge back into the left atrium during heartbeats.
Rheumatic fever: A complication of streptococcal infection that can cause scarring and damage to the valve leaflets.
Heart attack (myocardial infarction): Damage to the heart muscle can affect the supporting structures of the mitral valve.
Infective endocarditis: A bacterial infection of the inner lining of the heart that can destroy the valve leaflets.
Connective tissue disorders: Conditions such as Marfan syndrome or Ehlers-Danlos syndrome can weaken the valve tissue.
Dilated cardiomyopathy: Enlargement of the left ventricle can prevent the valve from closing properly (secondary form).

Symptoms

Mild mitral regurgitation may cause no symptoms for many years. As the condition progresses, the following symptoms may develop:

Shortness of breath (dyspnea), especially during physical activity or when lying flat
Fatigue and reduced exercise tolerance due to decreased cardiac output
Palpitations or irregular heartbeat, including atrial fibrillation
Chronic cough, particularly at night
Swelling in the legs and ankles (edema) in advanced heart failure
Heart murmur detectable by a doctor using a stethoscope

Diagnosis

Several diagnostic tools are used to confirm and assess the severity of mitral regurgitation:

Cardiac auscultation: A characteristic systolic heart murmur is heard over the apex of the heart.
Echocardiography (cardiac ultrasound): The primary diagnostic method, providing detailed images of the valve structure and function. A transesophageal echocardiogram (TEE) offers even more precise visualization.
ECG (electrocardiogram): May reveal signs of atrial fibrillation or left atrial enlargement.
Chest X-ray: Can show an enlarged heart shadow.
Cardiac catheterization: Used before surgery to evaluate the coronary arteries and assess hemodynamics in complex cases.

Severity Grading

Mitral regurgitation is graded on a scale from mild to severe (Grades I through IV). This grading, determined primarily by echocardiography, is critical for deciding when and how to treat the condition.

Treatment

Medical (Drug) Therapy

In mild to moderate mitral regurgitation without symptoms, regular monitoring is the main approach. Medications can relieve symptoms and reduce cardiac load, but cannot correct the valve leak itself:

ACE inhibitors or ARBs: Lower blood pressure and reduce the workload on the left ventricle.
Beta-blockers: Slow the heart rate and help protect the heart muscle.
Diuretics: Reduce fluid retention and decrease the burden on the heart.
Anticoagulants (blood thinners): Prescribed when atrial fibrillation is present to prevent stroke.

Interventional and Surgical Treatment

In cases of severe mitral regurgitation or when symptoms develop, a procedure is typically required:

Mitral valve repair: The preferred surgical approach, in which the existing valve is reconstructed rather than replaced. It offers better long-term outcomes and preserves the natural valve function.
Mitral valve replacement: Performed when repair is not feasible. The diseased valve is replaced with a mechanical or biological prosthesis.
MitraClip procedure (catheter-based therapy): A minimally invasive technique in which the valve leaflets are clipped together to reduce the backflow. It is suitable for high-risk surgical patients.

Prognosis and Course

With timely treatment, the prognosis for mitral regurgitation is generally favorable. However, if left untreated, it can progress to severe heart failure, atrial fibrillation, or permanent enlargement of the left heart. Regular cardiology check-ups are essential to determine the optimal timing for intervention.

References

Vahanian A. et al. - 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022.
Otto C.M. et al. - 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease. Journal of the American College of Cardiology, 2021.
Bonow R.O. et al. - Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th edition, Elsevier, 2022.

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