The mitral valve stops blood flowing back to the left atrium (the upper left chamber) from the left ventricle (the lower chamber). Patients can suffer from a leaky valve (mitral regurgitation) or narrowed valve (mitral stenosis). The management depends on symptoms and the severity of valve disease.
Mitral regurgitation is common and can arise from degenerative valve disease or from previous heart attacks or damage to the valves from infection. It can also occur because the main chamber of the heart (left ventricle) has become enlarged, so the anchor points of the mitral valve are further apart and the valve leaflets no longer meet perfectly. It can occasionally be congenital. If significant mitral regurgitation is left untreated, the left atrium and left ventricle become larger as the heart tries to compensate, causing them go into an abnormal rhythm (atrial fibrillation).
Mitral stenosis is less common and occurs following rheumatic fever. The valve leaflets and support structures which are normally thin and flexible become thinned and develop calcium deposits. If significant mitral stenosis is left untreated, the left atrium becomes larger due to the build up in pressure and the heart may go into an abnormal rhythm (atrial fibrillation). The blood pressure in the lungs may also increase.
Many cases of mitral valve disease have no symptoms and are found when a doctor listens to your heart or you undergo a scan of the heart.
Patients with mitral valve disease may develop breathlessness or ankle swelling, or may develop palpitations because their heart has gone into an abnormal rhythm - atrial fibrillation. Some patients with a narrowed mitral valve (mitral stenosis) also develop dizziness and the symptoms may be worse when exercising.
Your doctor will ask you to undergo and electrocardiogram (ECG) to look for strain on the heart and abnormal rhythms which often occur in mitral valve disease. The key test is an echocardiogram (ultrasound) which can assess if mitral valve disease is present and identify how severe it is and whether there is evidence it has caused problems with the rest of the heart.
If your mitral valve disease is thought to be significant you will be offered a transoesophageal echocardiogram to get a much clearer assessment of why the valve is abnormal and how severe the problem is.
If your heart is in a normal rhythm but it is suspected that it flips in and out of an abnormal rhythm your doctor will ask you to wear a 24h-hour ECG to see what is happening.
If it is decided that you may benefit from surgery you may need other tests such as a CT coronary angiogram to identify if you also have disease of the arteries which needs treatment at the same time.
The correct treatment depends on identifying the cause of mitral valve disease and assessing the severity.
For mitral regurgitation, a decision needs to made whether the leakiness is due to a problem with the valve or the shape of the left ventricle (which can cause mitral regurgitation when it is enlarged). If the left ventricle is the problem then treatment with medications such as ACE inhibitors and beta-blockers are recommended. If it is a problem with the valve, then surgery is likely to be the best option. In many cases the valve can be repaired which is the best option, but in some cases it may be necessary to replace the valve. Your doctor will be able to explain what the likelihood is of it being repaired. Sometimes a leaky valve can be due to problems with the arteries supplying the heart, in which case opening up the narrowing (with angioplasty of bypass surgery) may help. Sometimes a problem with the conduction system of the heart may be causing mitral regurgitation in which case a pacemaker (or cardiac resynchronisation therapy) may be useful.
For mitral stenosis, the treatments may include beta-blockers if your heart is fast or is in atrial fibrillation. You may also need blood thinning (anticoagulant) drugs. If the valve is very narrow it is sometimes possible to open the valve with a keyhole procedure from the top of the leg, but sometimes open heart surgery is needed to replace the valve.
Mitral valve diease can be complicated and a thorough assessment and interpretation of tests is required. Our expert Consultant Cardiologists are skilled in mitral valve assessment and are available for consultation on any day of the week and weekends as well.
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