What is the Mitral Valve?
The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. Normally the flaps are held tightly closed during left ventricular contraction (systole) by the chordae tendineae (small tendon "cords" that connect the flaps to the muscles of the heart). In Mitral Valve Prolapse (MVP), the flaps enlarge and stretch inward toward the left atrium, sometimes "snapping" during systole, and may allow some backflow of blood into the left atrium (regurgitation).
What are the symptoms of MR?
Depending on the severity of the leak, each individual may experience symptoms differently. Symptoms may include:
What is Mitral valve Prolapse?
Mitral valve prolapse, also known as click-murmur syndrome, Barlow's syndrome, balloon mitral valve, or floppy valve syndrome, is the bulging of one or both of the mitral valve flaps (leaflets) into the left atrium during the contraction of the heart. One or both of the flaps may not close properly, allowing the blood to leak backward (regurgitation). This regurgitation may result in a murmur (abnormal sound in the heart due to turbulent blood flow). Mitral regurgitation (backward flow of blood), if present at all, is generally mild.
It is estimated that mitral valve prolapse occurs in less than 3 percent of the population.
What is Mitral Valve Regurgitation?
Mitral valve regurgitation (MR), also known as a leaking mitral valve, Barlow's syndrome, occurs when one or both of the flaps may not close properly, allowing the blood to leak backward (regurgitation). This regurgitation may result in a murmur (abnormal sound in the heart due to turbulent blood flow). Mitral regurgitation (backward flow of blood), if present at all, is generally mild.
How is Mitral Valve Regurgitation (including Mitral Valve Prolapse) Treated?
The standard of care for patients with symptomatic mitral regurgitation (including mitral valve prolapse) is mitral valve surgery repair or replacement. This can be performed via minimally invasively and with a catheter (Mitraclip). RWJUH also offers investigational devices in the setting of clinical trials.
What is Mitral Valve Repair?
Mitral valve repair is the best option for nearly all patients with a mitral regurgitation (a leaking valve) and for many with a mitral stenosis (a narrowed valve). When possible valve repair is preferable, because a person's own tissues are used.
Mitral valve repair can be performed minimally invasively and with a catheter (Mitraclip)
What are the advantages of mitral valve repair?
How is MR Diagnosed?
Persons with MR often have no symptoms and detection of a murmur may be discovered during a routine examination.
MR may be detected by listening with a stethoscope revealing a a murmur. The murmur is caused by some of the blood leaking back into the left atrium.
In addition to a complete medical history and physical examination, diagnostic procedures for MR may include any, or a combination, of the following:
In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:
What is the risk of mitral valve surgery?
For asympotmatic patients undgoing mitral valve surgery, the risk of peri-operative death is significantly less than 1 in 100. Furthermore, after a successful valve repair the need for reoperation is less than 5 in 100 at 20 years.
What are the Causes of Mitral Regurgitation?
The most common cause of primary mitral regurgitation in the United States (causing about 50% of primary mitral regurgitation) is myxomatous degeneration of the valve. This causes a stretching out of the valve leaflets and the chordae tendineae. The elongation of the valve leaflets and the chordae tendineae prevent the valve leaflets from fully coapting when the valve is closed, causing the valve leaflets to prolapse into the left atrium, thereby causing mitral regurgitation.
Ischemic heart disease causes mitral regurgitation by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valve annulus.
Rheumatic fever and connective tissue disease (e.g. Marfan's syndrome and Ehlers Danlos Syndrome) are other typical causes of mitral regurgitation.
Secondary mitral regurgitation is due to the dilatation of the left ventricle, causing stretching of the mitral valve annulus and displacement of the papillary muscles. This dilatation of the left ventricle can be due to any cause of dilated cardiomyopathy, including aortic insufficiency, nonischemic dilated cardiomyopathy. It is also called functional mitral regurgitation, because the papillary muscles, chordae, and valve leaflets are usually normal.
Acute mitral regurgitation is most often caused by infaction of the heart valve. Papillary muscle rupture or dysfunction, including mitral valve prolapse are also common causes in acute cases.