Mitral valve regurgitation or Mitral valve insufficiency is also known as Mitral valve incompetence. This occurs when both the leaflets of the valve do not reach each other when the mitral valve is shut. Since the leaflets do not reach each other or meet, a small amount of blood that should ideally be pushed to the aorta flows back through the diseased valve, back into the atrium (left), when the ventricle (left) contracts. Due to the increased pressure in the atrium (left) the blood flows back to the lungs. The heart needs to work extra hard because of the backward flow of the blood. This results in the ventricle (left) dilating and eventually failing.
A� Rheumatic fever
A� Prolapse of the Mitral valve
A� Congenital birth defects of the valve, CAD (coronary artery disease - also known as ischemic mitral regurge because of less supply of blood to the muscles that control the valves) and infective endocarditis.
A� Myxoid degeneration - Here, a part of the heart tissue is weakened, making the valve prone to being incompetent. This can affect any of the various parts of the mitral valve such as the chordae which can get ruptured (the chordae is the part of the mitral valve that attaches it to underlying muscle).
A� Mitral valve incompetence can sometimes occur suddenly because of the rupture of the papillary muscles as a result of a heart attack or even as a complication of a balloon mitral valvotomy. In these cases the patient's condition becomes critical and he/she will require immediate surgical intervention.
Symptoms and signs:
A� Fatigue or chronic weakness.
A� Cough (sometimes with blood) and shortness of breath
A� In sudden and severe cases, the dyspnea (shortness of breath) is worse and the patient may require a mechanical respirator to help ease breathing
A� On physical examination, a physician will be able to hear a murmur over the heart
Diagnostic Tests: To diagnose and also to determine a treatment for valve disease, the doctor will ask for a full medical history and perform a thorough and complete physical exam. He will also order some or all of the special diagnostic testings that are mentioned below:
Chest x-ray - These will provide information regarding the size of the heart (enlarged in such a case) and the four chambers of the heart. It will also provide information regarding the lungs (congested).
Electrocardiogram- This test records the changes in the electrical activity that occurs during a heartbeat. Atrial fibrillation is one such common finding.
Echocardiogram - Commonly known as the echo test, this test uses an ultrasound to measure and examine the structure of the heart. An echo cardiogram will demonstrate the performance of the mitral valve and also the causes behind the mitral incompetence. It will also give information regarding the heart muscle function.
Cardiac catheterization or coronary arteriogram- The test permits visualization of the blood vessels and the measurement of the pressures within the heart chambers after injecting a contrast dye. This test is generally performed in patients who are 40 years and above. If the coronary arteries have a significant number of blocks, the cardiac surgeon will perform what is known as a coronary artery bypass surgery during the valve surgery.
This condition can be treated medically using diuretics and also with anti heart failure medications in the initial stages. However, in most of the cases, surgery is required to replace or repair the valve that is damaged. The surgeon will also determine the procedure that is best suited after taking into consideration factors such as age, medical history, the nature of the cardiac disease, lifestyle of the patient and the ability of the patient to take anticoagulants (medicines that prevent the clotting up of blood)
Artificial valves can be classified into three as follows.
Bioprosthetic valves: These are chemically treated valves taken from animals so that the rejection rate is minimal.
Mechanical valves: These are made of carbon, metal, and/or synthetics. These types of valves require anticoagulation to prevent the formation of blood clots.
Biologic valves: These are heart valves that are obtained from human donors after death. They are frozen for use at a later time (homograft).
Few valves can be repaired surgically to aid in efficient opening and closing. The two very common surgical procedures for the repair of valves are:
Ring Annuloplasty: In this procedure, the annulus which is the ring-like part of the valve, is made tight by placing a metal ring, cloth ring or tissue ring around the valve.
Valve Repair: In this procedure the leaflets, papillary muscles and/or chordae are restructured.