Mitral Valve Disease
What is It?
The mitral valve controls blood flow from the lungs into the heart, separating the upper left chamber (left atrium) and lower left chamber (left ventricle). In mitral valve disease, the valve can become narrowed (stenosis) or leak (regurgitation), allowing blood to flow backwards into the left atrium. This reduces the amount of oxygen-rich blood pumped around the body. Mitral valve disease is the most common form of heart valve disease, with mitral regurgitation being particularly common in older adults. Mitral valve prolapse, where the valve leaflets bulge backwards, affects up to 3% of the population.
What are the symptoms?
Problems with the mitral valve can cause shortness of breath (particularly on exertion or when lying flat), fatigue, palpitations, dizziness, swelling of the legs or abdomen, chest discomfort, and in severe cases, coughing up blood-tinged sputum. Many patients with mild disease have no symptoms for years, with symptoms developing gradually as the disease progresses.
What are the causes?
At One Heart Centre our cardiologists screen for all causes of mitral valve disease. Causes include:
- Mitral valve prolapse: A common cause of mitral regurgitation where the leaflets bulge backward.
- Age-related degeneration and calcification of the valve.
- Rheumatic fever: A major cause of mitral stenosis, typically from childhood infection.
- Heart attack and cardiomyopathy causing stretching of the valve.
- Infective endocarditis, congenital heart defects, and connective tissue disorders such as Marfan syndrome.
How is it investigated?
Your One Heart Centre cardiologist will take a detailed history and examination. If mitral valve disease is suspected, an ECG and echocardiogram will be arranged to confirm the diagnosis and assess severity. Ambulatory Holter monitoring may be used if arrhythmia is suspected, and a transoesophageal echocardiogram (TOE) provides more detailed imaging of the valve. Cardiac MRI, chest X-ray, and cardiac catheterisation may also be used in selected cases.
What are the treatments?
At One Heart Centre our cardiologists have post-fellowship training in managing mitral valve disease and will provide a personalised treatment plan for your mitral valve disease. Treatment depends on severity and symptoms, and may include:
- Surveillance: Mild to moderate disease is monitored with regular echocardiograms.
- Medical therapy: Medications to manage symptoms and associated conditions such as atrial fibrillation or heart failure, including diuretics, beta-blockers and blood thinners.
- Mitral valve repair: Surgical repair is often preferred over replacement to preserve the native valve.
- Mitral valve replacement or transcatheter procedures (such as MitraClip): For patients with severe disease unsuitable for repair or open surgery.