Mitral Regurgitation

MITRAL REGURGITATION OVERVIEW

Mitral regurgitation (MR), which is also known as mitral insufficiency, is a common heart valve disorder. 

With mitral regurgitation (MR), blood leaks backwards through the mitral valve and into the left atrium when the heart contracts. This means that less blood is pumped out of the heart to the body. If the amount of MR is small and does not progress, the backward leak has no significant consequences.

If significant (moderate to severe) MR is present, the left ventricle must work harder to keep up with the body's demands for oxygenated blood. Over time, the heart muscle (the myocardium) and circulatory system undergo a series of changes to maintain this increased demand. These changes generally occur in phases over many years, even decades, depending upon the amount of blood that is leaking backward and how the heart responds to MR. The cause of MR also influences how soon the heart begins to fail.

Information from https://www.uptodate.com/contents/mitral-regurgitation-beyond-the-basics

SYMPTOMS

Mitral valve regurgitation does not always have symptoms.

Sometimes it can cause:

If not treated, it can lead to:

Information from: https://www.nhs.uk/conditions/mitral-valve-problems/

CAUSES

Mitral regurgitation happens if the mitral valve cannot close properly.

This is usually caused by either:

  • the mitral valve becoming too floppy (mitral valve prolapse)

  • the ring of muscle around the valve becoming too wide

These problems often develop with age – for example, because of "wear and tear" over time or damage caused by untreated high blood pressure.

Mitral regurgitation can sometimes be caused by a problem such as:

  • cardiomyopathy – where the walls of the heart become stretched, thickened or stiff

  • endocarditis – infection of the inner lining of the heart

  • congenital heart disease – birth defects affecting the heart

Information from: https://www.nhs.uk/conditions/mitral-valve-problems/

TREATMENT

You might not need treatment if you do not have any symptoms. Your doctor may just suggest having regular check-ups to monitor your condition.

If you have symptoms or the problem with your valve is serious, your doctor may recommend:

  • medicines to relieve your symptoms – such as diuretics to reduce breathlessness and medicines for atrial fibrillation

  • open heart surgery – to repair or replace the mitral valve

  • keyhole surgery – a small clip is attached to the mitral valve to help it close; the clip is guided into the heart through a thin tube inserted into a vein in the groin. 

Information from: https://www.nhs.uk/conditions/mitral-valve-problems/

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Transcatheter Edge-To-Edge Repair (TEER)

TEER is a minimally invasive procedure used to repair a leaking mitral valve without the need for open-heart surgery.

 

The procedure is

  • Less invasive but is carried out using a general anaesthetic

  • Associated with faster recovery times with patients often returning home 2-3 days after the procedure

  • Only suitable for certain patients ie those who are ‘high risk’ for standard valve surgery

 

Unlike the traditional repair surgery, the TEER procedure doesn't need the chest to be opened. The doctors access the faulty mitral valve via a catheter (long thin tube) which is fed up to the heart from a vein in the leg.

 

The device is positioned just below the leaflets of the mitral valve using a steerable guide catheter. Once in position, the two leaflets of the valves are ‘grasped’ by the device, brought closer together in order to reduce or abolish the leak.

 

The use of TEER has grown significantly over the past decade, with over 80000 patients treated worldwide, and it is the most common minimally invasive (percutaneous) procedure to treat a leaking mitral valve.

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Patient Information Sheets

Leeds Teaching Hospitals NHS Trust Mitral Regurgitation Patient Information Sheet

Aortis Stenosis and TAVI

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