Severe mitral regurgitation (MR) occurs when the mitral valve does not close properly, allowing blood to leak backward from the left ventricle into the left atrium. This places extra strain on the heart and can lead to heart enlargement, heart failure symptoms, and reduced quality of life if untreated. Mitral regurgitation can be caused by valve degeneration, infection, rheumatic heart disease, heart attacks, or conditions that stretch the left ventricle.
Causes and Risk Factors
Severe mitral regurgitation may result from:
- Mitral valve prolapse (MVP)
- Degenerative valve disease
- Rheumatic heart disease
- Infective endocarditis
- Heart attack–related damage
- Dilated cardiomyopathy
- Congenital valve abnormalities
Symptoms of Severe Mitral Regurgitation
Symptoms may develop gradually or suddenly, depending on the cause. Common signs include:
- Shortness of breath, especially during activity or lying flat
- Fatigue and reduced exercise tolerance
- Heart palpitations or irregular heartbeat
- Swelling of the legs, ankles, or abdomen
- Chest discomfort
- Persistent coughing
- Lightheadedness
Some patients have no symptoms at first, which is why early diagnosis is important.
Diagnosis
At Premier Cardiology, we use advanced diagnostic testing to evaluate the severity and cause of mitral regurgitation, including:
- Echocardiogram (TTE) – primary test to assess valve structure and leakage
- Transesophageal Echocardiogram (TEE) – detailed imaging when more clarity is needed
- Electrocardiogram (EKG) – detects rhythm abnormalities
- Holter Monitor or Event Monitor – monitors ongoing arrhythmias
- Cardiac MRI – evaluates heart size and function
- Stress testing – studies how the heart performs under activity\
Your cardiologist will combine these results to determine the best treatment plan.
Treatment Options
Treatment depends on severity, symptoms, heart function, and the cause of the valve problem.
Medical Management
Medications may help relieve symptoms and reduce strain on the heart:
- Diuretics
- Blood pressure–lowering medications
- Medications for atrial fibrillation or arrhythmias
These do not fix the valve but can help manage symptoms until a procedure is recommended.
Minimally Invasive Procedures
For patients who are high-risk for open-heart surgery:
MitraClip (Transcatheter Edge-to-Edge Repair)
- A minimally invasive catheter-based procedure
- Clips the mitral valve leaflets to reduce leakage
- Shorter recovery and lower surgical risk
This is often recommended for patients with severe symptomatic MR who are not candidates for surgery.
Surgical Treatment
Severe MR often requires surgical correction, especially when heart function begins to decline.
Mitral Valve Repair
- Preferred when possible
- Preserves the natural valve
- Excellent long-term outcomes
Mitral Valve Replacement
- Used when the valve cannot be repaired
- Mechanical or tissue replacement options
Your surgeon will determine the best approach based on valve anatomy.
When to Seek Care
You should schedule an evaluation if you:
- Have symptoms of shortness of breath or fatigue, or you’ve been told you have a heart murmur
- Have a history of mitral valve prolapse
- Have been diagnosed with moderate or severe MR
- Experience palpitations or irregular heart rhythm.