February 20, 2020

Do You Have a “Leaky Heart”? What You Need to Know about Mitral Valve Regurgitation

 heart image in person's chest illustrationBy Robert A. Poarch

Our heart works hard, beating more than 100,000 times and pumping about 2,000 gallons of blood each day. During the day, we don’t think much about our heart. Until it starts to give us problems, such as a “leaky heart.”

What it means to have a leaky heart valve. “A ‘leaky’ heart valve refers to a valve that is allowing some proportion of blood flow to go ‘backward’ in the wrong direction (i.e., regurgitant) as the heart is beating,” said Michael Chenier, MD, MPH, a structural interventional cardiologist with Asheville Cardiology Associates. This can happen in any of the four valves in the heart. Valvular regurgitation severity is determined by various measurements and findings on echocardiography (ultrasound imaging of the heart) and is graded as trivial, mild, moderate or severe. “Severe valvular regurgitation can have deleterious effects on the heart, including the development or worsening of congestive heart failure with symptoms of shortness of breath, exertional fatigue and other problems,” said Dr. Chenier.

Mitral valve regurgitation is the most common valve disease in the United States. Mild mitral regurgitation affects up to 20 percent of healthy people and has no clinical consequence. Nearly 10 percent of people age 75 or older have moderate to severe mitral regurgitation, which is of clinical concern.

Signs of valve regurgitation are similar to congestive heart failure. “Symptoms include shortness of breath, fatigue with exertion, swelling in the lower extremity (edema) and sometimes abnormal heart rhythms, like atrial fibrillation,” said Dr. Chenier.

Regurgitation in the heart can be related to your age, a birth defect or heart disease. “Most often, the leak in the valve is caused by stretching of the left-sided chambers of the heart due to congestive heart failure causes, like a heart attack,” said Dr. Chenier. “Or anatomic problems with the mitral valve itself, such as stretching or tears.” If this extra strain on your heart is left untreated, heart failure can occur.

There are several ways to detect mitral valve regurgitation. Common forms of diagnosis include echocardiogram, cardiac MRI and certain types of stress tests.

The treatment goal is to minimize symptoms and avoid the conditions getting worse. Medication will likely be prescribed to help manage your symptoms. Open-heart surgery to repair or replace the mitral valve is the most common method to fix mitral regurgitation. For some patients, less invasive techniques are available, which include MitraClip. Your doctor may suggest mitral valve repair or replacement. “Transcatheter repair or replacement. “Transcatheter mitral valve replacement with certain devices are inpatient minimally invasive procedures,” said Dr. Chenier. “The MitraClip is inserted into the mitral valve from the femoral vein in the leg. Patients typically are discharged home after one night in the hospital.”

Here are the risk factors for “leaky heart”:
• Family history of mitral valve problems
• Having a heart attack or heart disease
• Having had endocarditis or rheumatic fever
• Born with an abnormal mitral valve
• Natural mitral valve deterioration due to age

Do you know your heart health? Take our online quiz to find out your risk factors and what you can do to improve your heart at missionhealth.org/heartstrong.

Michael Chenier, MD, MPH, is a structural interventional cardiologist with Asheville Cardiology Associates.
IBM Watson Health has recognized Mission Heart as a 50 Top Cardiovascular Hospital. To learn more about the Advanced Cardiac Care Clinic, call 828-213-0152 or visit missionhealth.org/heartstrong.