Mitral Valve Regurgitation: Treatment Overview

Content provided by Healthwise

Treatment Overview

Treatment for chronic mitral valve regurgitation (MR) includes monitoring your heart function and symptoms, as well as treating symptoms as they develop. If MR becomes severe, the mitral valve will need to be repaired or replaced. Treatment for acute MR is immediate. Medicines and urgent surgery are usually necessary.

As you review your treatment options, consider the following:

• If you have mild-to-moderate chronic MR and no symptoms, your doctor may only monitor your condition.
• If you have moderate-to-severe MR but no symptoms, your doctor may suggest repair or replacement of the mitral valve before symptoms develop, to prevent further heart damage.
• If you have chronic MR, medicines may be used to treat your symptoms and prevent complications. For acute MR, medicines are used to stabilize your condition, but urgent surgery is usually necessary.
• Severe MR generally requires valve repair or replacement to prevent heart failure. Repairing a damaged valve is preferred over replacement.

Initial treatment

Initial treatment for chronic mitral valve regurgitation depends on whether you have symptoms and how severe the regurgitation is. If you don't have symptoms and you only have mild-to-moderate regurgitation, your doctor may only monitor your heart and valve function with an echocardiogram.

The echocardiogram uses painless ultrasound waves to check how well your heart is pumping blood (ejection fraction) and to measure the size of your left ventricle. The smaller the ejection fraction, the harder your heart must work to pump a sufficient volume of blood.

Surgery is recommended when ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹ If you need surgery, your doctor may suggest repairing or replacing your mitral valve to avoid further heart damage. When you begin to have symptoms, the regurgitation is advanced, and you will need surgery to prevent heart failure.

Your doctor may prescribe medicines, such as:

• Vasodilators, such as ACE inhibitors, to help widen blood vessels and help the heart pump more efficiently, if you have symptoms of MR.
• Anticoagulants, such as warfarin (Coumadin), to prevent blood clots if you also have atrial fibrillation.
• Other medicines to control heart rate if you have atrial fibrillation, including beta-blockers, digoxin, or calcium channel blockers.
• Diuretics, for symptoms of heart failure and to reduce the workload on your heart.

Initial treatment for acuteMR includes use of the above medicines as necessary to stabilize your condition. If medicines don't help, an intra-aortic balloon pump may be necessary. This device has a balloon attached to the end of a catheter and is threaded up into the aorta, the main artery leaving the heart. The balloon inflates and deflates in sequence with your heartbeat to help circulate blood, decrease the heart's workload, and increase blood flow. Urgent surgery to repair or replace your mitral valve will also be necessary, as well as treatment for the cause of the acute MR.

Ongoing treatment

Like initial care for chronic mitral valve regurgitation (MR), ongoing treatment with medicines or surgery varies according to the progression of the disease.

Your doctor may prescribe medicines to help control high blood pressure.

You will need periodic echocardiograms to see if regurgitation is getting worse, and to check the size of your left ventricle and how well it is working. In chronic MR, the left ventricle expands in size as it tries to accommodate the larger volume of blood going into the chamber. The larger the left ventricle, the more advanced the MR.

Your doctor will also monitor your heart's ejection fraction, which is a measure of how well your heart is pumping blood. Ejection fraction is the amount of blood pumped out of the ventricle (stroke volume) divided by the total amount of blood in the left ventricle at rest. The smaller the ejection fraction, the harder your heart must work to pump a sufficient volume of blood.

Surgery is recommended when ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹ If you need surgery, your doctor may suggest repairing or replacing your mitral valve to avoid further heart damage. When you begin to have symptoms, the regurgitation is advanced, and you will need surgery to prevent heart failure.

Treatment if the condition gets worse

If your mitral valve regurgitation becomes severe and you develop symptoms of heart failure, such as shortness of breath, swelling, and fatigue, surgery to repair or replace your mitral valve will be necessary. Surgery is also recommended when your ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹

Some doctors believe it's best to repair or replace the mitral valve before you develop severe symptoms because it leads to better long-term health. On the other hand, surgery to correct MR is a major procedure that has its own risks and complications. Even if you have no symptoms, talk to your doctor about the benefits of surgery, along with your heart's condition, your age, and your overall health.

The decision between repairing or replacing the valve depends on the type of damage to the mitral valve. For instance, repair is more successful if there is limited damage to certain areas of the mitral valve flaps (leaflets) or to the chordae tendineae, the tough fibers that control movement of the mitral valve leaflets. But replacement is usually preferred for people who have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue.

Repair may be done by reshaping the valve or removing excess tissue, adding support to the valve ring, or attaching the valve to other cordlike tissues in the heart (chordal transposition).

With replacement, the badly damaged valve is removed, and a mechanical (plastic or metal) or a bioprosthetic valve (usually made from pig tissue) is sewn into place. If you receive a mechanical valve, you are more likely to develop blood clots in the heart than if you receive a bioprosthetic valve, so you will need anticoagulant medicine for the rest of your life to prevent clots from forming and possibly causing a stroke.

Last updated:	March 27, 2008
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC