Mitral valve leakage: Symptoms, causes, and newer treatment options

Advances in cardiac care are expanding treatment choices beyond traditional surgery. While open-heart surgery remains a trusted and effective approach for many heart conditions, certain valve disorders, such as mitral valve leakage (or mitral regurgitation), can now also be managed with less invasive techniques. These evolving options are particularly valuable for patients who may not be suited for surgery due to specific health or anatomical factors.

What is mitral valve leakage?
Mitral Valve Leakage, also known as mitral regurgitation, is a symptomatic cardiovascular condition wherein the mitral valve does not close tightly. This causes blood to flow backwards into the left atrium when the left ventricle contracts and onward into the lungs, resulting in severe blood pressure and symptoms. This is a serious heart condition usually observed in patients who have experienced heart attacks and have a dilated heart, but it can also occur in patients who are elderly and have a diseased mitral valve, which does not close properly.

Common causes of mitral regurgitationSeveral factors can contribute to the weakening or damage of the mitral valve, including:

• Age-related degeneration
• Previous heart attacks, which may damage the surrounding muscles
• Rheumatic fever from untreated gum or throat infections
• Congenital defects (present from birth)
• Valve infections, such as infective endocarditis
• Atrial fibrillation and long-standing high blood pressure

In many cases, symptoms may not appear for years because the heart compensates for the leak, pumping harder to maintain normal circulation. However, as the condition progresses, the heart may no longer be able to cope.

Recognising the symptomsSymptoms often appear subtly and worsen over time. These may include:

• Difficulty breathing, especially while lying down
• Irregular heartbeat or palpitations
• Swelling in the feet or ankles
• Persistent fatigue
• Chest discomfort
• Light-headedness or fainting

If left untreated, severe regurgitation can lead to complications such as heart enlargement, arrhythmias, or even heart failure.

Early diagnosis makes a differenceFortunately, diagnosing mitral valve leakage is relatively straightforward. Common methods include:

• Echocardiogram – an ultrasound of the heart
• Electrocardiogram (ECG) – to assess heart rhythm
• X-ray – to detect any enlargement of the heart
• Fetal echocardiogram – to identify congenital defects during pregnancy

Treatment options: Medication, surgery, and emerging procedures1The choice of treatment depends on the severity of the leakage and the patient’s overall health.

1. Mild cases may be managed with medication such as:

• Diuretics, to reduce fluid buildup
• Beta-blockers or ACE inhibitors, to ease the heart’s workload
• ARNI or SGLT-2 inhibitors, in newer heart failure management protocols

2. In more severe cases, surgical or transcatheter treatment might be recommended.

While surgery and transcatheter procedures are mainly used for severe valve disease, early diagnosis, patient education, regular check-ups, and medication are key to managing mild or moderate cases and those at risk, as per the 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease.

Where minimally invasive options come in1
Some patients with mitral regurgitation are too weak or sick to undergo open-heart surgery, i.e., are at a high or prohibitive surgical risk.

While not suitable for all, doctors can use a less invasive procedure called TEER, where a small clip is used to bring the flaps of the valve closer together, thereby reducing the leak. The call is taken based on factors like:

• Age & frailty
• Cardiac or other major organ system compromise
• Risks or complications related to the procedure itself

This procedure has been found to be safe and helpful in easing symptoms in such high-risk patients, as per the AHA/ASA Journals1.

Recovery and outlookPost the TEER procedure, the patient is kept under observation in an ICU for 1 - 3 days to monitor heart rhythm, valve function, blood pressure, kidney function, symptoms of bleeding, arrhythmias or for any other valve-related complications2. As per various sources, patients undergoing TEER typically spend a short time3 in the hospital, often 3 to 5 days, if they are doing well.

However, it is essential to schedule follow-up appointments with the concerned doctor to monitor valve performance and heart function after treatment, as every patient’s condition is unique.

Heart repair without surgery is possible now, and it is also increasingly becoming the standard approach in carefully selected cases. For patients with severe mitral valve leakage who cannot undergo open-heart procedures, minimally invasive options like TEER offer a new lease on life.

Sources:* https://www.ncbi.nlm.nih.gov/books/NBK553135/

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
2. https://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.30866
3. https://www.jscai.org/article/S2772-9303%2824%2900143-1/pdf

Disclaimer: The views and opinions expressed in the story are independent professional judgments of the doctors/experts, and TIL does not take any responsibility for the accuracy of their views. This should not be considered a substitute for medical advice. Please consult your treating physician for more details. This article has been produced on behalf of Meril Life Sciences by Times Internet’s Spotlight team.