Mitral valve disease refers to conditions in which the mitral valve, located between the left atrium and left ventricle, does not open or close properly. This can disrupt normal blood flow through the heart and place extra strain on the left atrium, left ventricle, and lungs.
Mitral valve disease is common and ranges from mild abnormalities requiring only monitoring to severe disease that can lead to heart failure, arrhythmias, or pulmonary hypertension if left untreated.
How the Mitral Valve Normally Works
The mitral valve opens to allow blood to flow from the left atrium into the left ventricle and closes tightly during ventricular contraction to prevent blood from leaking backward. Normal valve function ensures efficient forward blood flow with each heartbeat.
When the valve becomes narrowed or leaky, the heart must work harder to maintain circulation.
Types of Mitral Valve Disease
Mitral valve disease generally falls into two main categories, although some patients may have features of both.
Mitral Regurgitation
Mitral regurgitation occurs when the valve does not close completely, allowing blood to leak backward into the left atrium during contraction. This backward flow increases pressure in the atrium and lungs and can eventually weaken the left ventricle.
Mitral Stenosis
Mitral stenosis occurs when the valve becomes thickened, stiff, or narrowed, restricting blood flow from the left atrium to the left ventricle. This leads to elevated pressure in the lungs and reduced cardiac output.
Common Causes of Mitral Valve Disease
Mitral valve disease may result from degenerative changes, rheumatic heart disease, infection, congenital abnormalities, or damage to the heart muscle.
Mitral regurgitation is often caused by valve degeneration, mitral valve prolapse, or dilation of the left ventricle. Mitral stenosis is most commonly related to rheumatic heart disease.
Symptoms of Mitral Valve Disease
Symptoms depend on the type and severity of disease and may develop gradually.
Common symptoms include shortness of breath, fatigue, reduced exercise tolerance, palpitations, swelling of the legs or abdomen, and in advanced cases, chest discomfort or fainting.
Some patients remain asymptomatic for years despite significant valve disease.
How Mitral Valve Disease Is Diagnosed
Diagnosis relies primarily on echocardiography, which allows detailed assessment of valve structure, severity of leakage or narrowing, heart chamber size, and heart function.
Electrocardiography, chest imaging, and sometimes advanced imaging such as cardiac MRI are used to assess complications and guide treatment decisions.
Treatment Options for Mitral Valve Disease
Treatment of mitral valve disease is highly individualized and depends on valve anatomy, disease severity, symptoms, heart function, and overall health. The goals of treatment are symptom relief, prevention of complications, and preservation of heart function.
Medical Therapy
Medications do not correct the structural valve problem but are often used to control symptoms and manage complications.
Drug therapy may be prescribed to reduce fluid congestion, control heart rate, manage high blood pressure, or treat associated arrhythmias such as atrial fibrillation. In patients with mitral stenosis, medications may help slow the heart rate and improve filling time.
Medical therapy is often used while monitoring disease progression or as supportive treatment in patients who are not immediate candidates for intervention.
Mitral Valve Repair
When feasible, mitral valve repair is preferred over valve replacement because it preserves the patient’s own valve and maintains more natural heart function.
Surgical repair techniques may include reshaping valve leaflets, repairing or replacing supporting structures, and reinforcing the valve ring with annuloplasty. Repair is most commonly used for degenerative mitral regurgitation and provides excellent long-term outcomes when performed in experienced centers.
In selected patients, transcatheter mitral valve repair techniques may be used. One widely used catheter-based approach is MitraClip, which reduces leakage by bringing the valve leaflets closer together without open-heart surgery. This option is typically reserved for patients with significant regurgitation who are at high surgical risk.
Mitral Valve Replacement
If the valve is too damaged to be repaired, mitral valve replacement becomes necessary. The diseased valve is replaced with either a mechanical valve or a biological (tissue) valve.
Valve replacement may be performed through traditional open-heart surgery or, in selected cases, using evolving catheter-based techniques. The choice of valve type depends on patient age, lifestyle, ability to take long-term anticoagulation, and individual preferences.
Balloon Mitral Valvotomy
In selected patients with mitral stenosis and favorable valve anatomy, a balloon mitral valvotomy may be performed. This catheter-based procedure widens the narrowed valve opening and can significantly improve symptoms without the need for open-heart surgery.
Treatment of Complications
Mitral valve disease often leads to secondary problems such as atrial fibrillation, pulmonary hypertension, or heart failure. Treating these associated conditions is a key part of management and improves overall outcomes.
Anticoagulation may be required in patients with atrial fibrillation or certain valve conditions to reduce stroke risk.
Follow-Up and Timing of Intervention
Regular follow-up with echocardiography is essential, even in asymptomatic patients. Timely intervention—before irreversible heart damage occurs—is one of the most important determinants of long-term outcome.
Decisions regarding repair or replacement are best made in experienced heart valve centers using a multidisciplinary approach.
In Summary
Mitral valve disease encompasses a range of conditions that impair normal blood flow through the heart. While mild disease may require only monitoring, more advanced cases benefit from medical therapy, valve repair, or valve replacement. With modern surgical and catheter-based techniques, many patients achieve excellent symptom relief and long-term outcomes when treated at the appropriate time.
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Reference: Mitral Valve Disease
