by Harold Dauerman, MD, UVM You may have a leaking heart if your mitral valve is damaged. What is the mitral valve you ask? It’s located between the left atrium (where blood enters the heart from the lungs) and the left ventricle of the heart (which pumps the blood to your entire body). Mitral valve regurgitation means that your mitral valve is letting blood leak backward into the atrial chamber of the heart.
How Heart Valves Work
Heart valves work like one-way gates, helping blood flow in one direction between heart chambers and out of the heart. The mitral valve is on the left side of your heart. It lets blood flow from the upper to the lower heart chamber. See a picture of mitral valve regurgitation. When the mitral valve is damaged – for example, by an infection or with aging – it may no longer close tightly. This lets blood leak backward, or regurgitate, into the upper chamber. Your heart has to work harder to pump this extra blood. Small leaks are usually not a problem. More severe cases weaken the heart over time and can lead to heart failure. There are two types of mitral regurgitation:
Harold Dauerman, MD (Photo: LCOM Creative Services)
Primary regurgitation means there is a problem with the anatomy of the valve. The valve does not work well and does not close tightly. This might happen due to calcium buildup on the valve. It can also happen in people who have mitral valve prolapse. Secondary regurgitation means another heart problem causes the valve to not close tightly. The anatomy of the valve is typically normal. The heart problem, for example cardiomyopathy (Heart failure due to a weak heart muscle, such as from a viral infection), affects the heart muscle, and this causes regurgitation.
Symptoms of Mitral Valve Regurgitation
Symptoms of mitral valve regurgitation include being tired or short of breath when you are active. If your heart weakens because of your mitral valve, you may start to have symptoms of heart failure. Call your doctor if you start to have symptoms or if your symptoms change.
- Shortness of breath with activity, which later develops into shortness of breath at rest and at night.
- Extreme tiredness and weakness.
- A buildup of fluid in the legs and feet, called edema.
New Treatment Option for Patients
The MitraClip device is a small clip that treats mitral regurgitation. It allows your mitral valve to close more completely, helping to restore normal blood flow through your heart.
Transcatheter Mitral Valve Repair (TMVR) is a new treatment option for high risk patients with severe mitral regurgitation due to a primary structural cause of mitral valve leak.
In 2013, the FDA approved a device called Mitraclip, a small clip that is attached to your mitral valve. We access the mitral valve with a thin tube (called a catheter) that is guided through a vein in your leg to reach your heart. Once placed, the clip closes the leaky valve.
More than 25,000 patients have been treated worldwide and have seen improvement in heart failure related symptoms. The UVM Health Network started offering this treatment option in January 2017. It is for patients deemed appropriate by our heart team, including a cardiac surgeon, heart failure specialist, and interventional cardiologist. We very recently treated a 90-year-old, referred from Copley Hospital. He had lifestyle-limiting congestive failure. We found that he had severe mitral regurgitation. He was also a high risk for surgery, so we advised MitraClip as it is less invasive. Eighteen hours after the valve repair, he was smiling from his hospital bed.
This minimally invasive therapy complements and expands the surgical and medical treatment options already being offered to patients with this high risk disease.
Harold Dauerman, M.D., is an interventional cardiologist at the University of Vermont Medical Center and professor of medicine at the Larner College of Medicine at the University of Vermont. He is the author of the information, below, which originally appeared on the UVM Medical Center blog and can also be found here.