What Is Mitral Valve Regurgitation?

Medically Reviewed by Zilpah Sheikh, MD on February 18, 2024
Written by Matt McMillen, WebMD Editorial Contributor, Kristin Mitchell
15 min read

When your heart pumps blood, it’s supposed to follow a specific path in one direction. But sometimes, it goes the wrong way.

Mitral valve regurgitation is when your blood isn’t going where it should. With this condition, some of it leaks backward instead of flowing out to the rest of your body.

You may feel tired and out of breath if you have it. You may also have higher blood pressure and a buildup of fluid in your lungs.

Your doctor may refer to it by one of its other names, which include:

  • Mitral valve insufficiency or mitral insufficiency
  • Mitral regurgitation
  • Mitral valve incompetence or mitral incompetence
  • Leaky heart valve

They can confirm whether you have a mild case and might not even need treatment, or a more serious situation that will need medication or surgery.

There are two types of mitral valve regurgitation, depending on the cause, including:

  • Primary or degenerative mitral valve regurgitation. In this type, something has damaged the valve so that it can’t close properly. For example, infections and inflammation can damage your mitral valve.

  • Secondary or functional mitral valve regurgitation. In this type, there’s nothing wrong with your mitral valve, but a problem elsewhere in your heart prevents it from functioning properly. Heart failure and arrhythmias, for example, can cause secondary mitral valve regurgitation.

Both types of mitral valve regurgitation can be either acute (developing suddenly) or chronic (developing gradually over time).

Before you understand the details of how blood can flow the wrong way in one part of your heart, you need to know how things should work.

The heart has four chambers: the left and right atrium on top and, below them, the left and right ventricles. As your heart beats, it draws blood from the body into the right atrium. This chamber sends it down to the right ventricle. From there, your blood is pumped to the lungs to pick up oxygen.

When that oxygen-rich blood goes back to the heart, the left atrium takes it in and passes it down to the left ventricle. That chamber contracts, or squeezes, to send it to your body.

You have a passageway between the left atrium and the left ventricle. That is the mitral valve.

The mitral valve is supposed to be a one-way passage between your heart's left atrium and left ventricle. It has two flaps, called leaflets. With each contraction of your heart, these leaflets open to allow blood to flow through, and then they close tightly. Along with the other three valves in your heart, the opening and closing of your mitral valve helps keep your blood flowing properly.

But sometimes, the mitral valve doesn’t seal properly when it closes. This creates a leak that allows blood to flow backward through it, returning to the left atrium.

When this happens, you have mitral valve regurgitation. A small leak may not cause noticeable problems, but larger leaks force your heart to work harder to pump the right amount of blood. Over time, this can lead to serious complications, including heart failure and abnormal heart rhythms, also called arrhythmias. Mitral valve regurgitation can also be fatal.

Some people with this condition may not feel any symptoms, while others may have chest pain, shortness of breath, an irregular heartbeat, or dizziness, among other things.

If you have mild regurgitation you may not notice any symptoms. But if the condition worsens, you might have:

  • Heart palpitations, which happen when your heart skips a beat. They produce feelings in your chest that can range from fluttering to pounding and may be more likely to happen when you’re lying on your left side.
  • Coughing
  • Fatigueand shortness of breath. The blood coming through the left side of your heart fuels your body, bringing oxygen from your lungs to your cells. If some of that blood is flowing back into the heart instead, you might end up feeling tired or lightheaded, particularly if you’ve been active. In severe cases, you can find yourself feeling tired or short of breath even when you’re at rest.
  • Rapid breathing
  • Chest pain
  • Swelling of feet and legs. This is caused by a buildup of fluid in your body, known as edema. It’s a sign that your heart may be struggling to pump enough blood to the rest of your body.

Some other things you or your doctor may notice:

  • You get very tired more easily.
  • You have a heart murmur (blood whooshing or swishing around).
  • You have low blood pressure.
  • You might faint.

Some symptoms signal a medical emergency. Call 911 if you have any of the following symptoms, which can be a sign of acute heart failure:

  • Tightness in your chest
  • Feeling of suffocation
  • Heavy breathing
  • Breathing that's challenging when you're lying down
  • Low blood oxygen

Numerous health conditions can cause mitral valve regurgitation. They include:

  • Mitral valve prolapse. Often harmless and requiring no treatment, this condition causes the leaflets to bulge, or prolapse, into your left atrium rather than closing properly.
  • Rheumatic heart disease. This is caused by rheumaticfever, a condition that can develop if strep throat goes untreated. It causes inflammation that can damage your mitral valve.
  • Heart attack. This can damage the heart muscles that control your mitral valve, leading to sudden and severe mitral valve regurgitation.
  • Congenital heart defects. These are problems you’re born with, such as a cleft mitral valve, a rare condition in which one of your mitral valve leaflets has a split in it.
  • Cardiomyopathy. These are diseases of the heart muscle. The most common is ischemic cardiomyopathy, in which your heart muscle gets damaged due to lack of oxygen. Others include dilated cardiomyopathy and hypertrophic obstructive cardiomyopathy.
  • Damaged tissue cords. The tissue that holds the leaflets of your mitral valve in place can stretch and tear due to traumatic injury to your chest, as can mitral valve prolapse.
  • Infective endocarditis. This is inflammation of the lining of your heart’s valves and chambers. It’s a type of bacterial infection that can damage your mitral valve.

In addition to the above causes, your risk of developing mitral valve regurgitation rises if you:

  • Are over age 65.
  • Have a family history of heart valve disorders or early heart disease.
  • Have lifestyle habits that can lead to other types of heart disease, such as smoking, lack of exercise, poor diet, and obesity.
  • Use a medical device, such as an implanted cardioverter defibrillator or pacemaker, which can rub against your mitral valve and cause scarring. They also can stretch your mitral valve.
  • Have other conditions that affect your heart, including high blood pressure, diabetes, and autoimmune diseases such as lupus, and heart conditions.
  • Have undergone radiation therapy for cancer.

Mitral valve regurgitation can lead to very serious and even life-threatening conditions. These include:

  • Heart failure. Severe mitral valve regurgitation reduces the amount of blood flowing out of your heart to the rest of your body. To make up for this, your heart has to work harder to pump enough blood. Over time, this causes your heart’s main pumping chamber, your left ventricle, to become larger and weaker. This results in heart failure, in which your heart can’t do its job adequately.
  • Atrial fibrillation. This is an arrhythmia that causes an erratic, often rapid heartbeat. This makes it harder for your heart to pump blood efficiently. Instead, blood backs up and pools in your left atrium, where it thickens. This allows clots to form. If one of those clots gets into your bloodstream and travels to your brain, it can cause a stroke.
  • Pulmonary hypertension. This means high blood pressure in the lungs. It narrows the arteries in your lungs, which makes it harder for your heart to pump blood from your heart to your lungs. This can lead to heart failure, blood clots in your lungs, abnormal heart rhythms, and other serious complications. It also can lead to an irregular or uneven heartbeat or a stroke.

Doctors usually find a problem with your heart valve by listening to your heart and lungs with a stethoscope. If blood is leaking back into your left atrium, it will produce a murmur or a whooshing sound. That will lead to several tests to determine whether you have mitral valve regurgitation or another condition that could be causing the murmur. These tests include:

  • Transthoracic echocardiogram (TTE). This noninvasive and painless test uses sound waves to create detailed pictures of your mitral valve as well as images of blood flow through your heart. This will help your doctor diagnose mitral valve regurgitation as well as how severe it is. It also can be used to determine the cause, such as a birth defect, rheumatic heart disease, or any other condition affecting your mitral valve.
  • Transesophageal echocardiogram (TEE). This test, which also uses sound waves to image your heart, may be necessary if your doctor needs more detailed pictures of what’s happening in your heart. During the test, your doctor will guide a long, thin tube down your throat to your chest. A device called a transducer, attached to the tube, bounces sound waves off your heart to create echoes, which a computer then converts to highly detailed pictures.
  • Electrocardiogram (ECG or EKG). During this painless, noninvasive test, sensors are attached to your chest, and sometimes to your arms and legs. These sensors transmit signals that show how your heart beats. This test can identify arrhythmias related to mitral valve regurgitation.
  • Chest X-ray. This provides pictures that can identify whether you have an enlarged heart or fluid in your lungs.
  • Cardiac magnetic resonance imaging (MRI). This test creates images of your heart using magnetic fields and radio waves. It helps your doctor determine the severity of your mitral valve regurgitation. It also can provide valuable information about your left ventricle, your heart’s lower left chamber.
  • Exercise and stress tests. This tests how your heart responds to exercise and whether your mitral valve regurgitation symptoms occur during physical activity. The test will be conducted on a treadmill or stationary bike. If you can’t exercise, you will be given a medication that affects the heart the same way that exercise does.
  • Cardiac catheterization. Though not frequently used to diagnose mitral valve regurgitation, your doctor may recommend this test if other tests have not had clear results. This test involves inserting a thin and flexible tube called a catheter into a blood vessel in your arm and groin. Your doctor guides it to your heart. Once there, a special dye flows through the tube into your heart. This dye enables your doctor to create clearer X-ray pictures of your heart’s chambers.

You may get follow-up tests from time to time, depending on your case.

When you’re diagnosed, your doctor will determine the current stage of your mitral valve regurgitation. The stage depends on a few different factors:

  • The severity of the disease
  • Your symptoms
  • The structure of your mitral valve
  • How blood flows through your heart and lungs.

The four stages are:

  • Stage A: At risk. You have no symptoms and only minor signs of valve problems, such as mild mitral valve prolapse or mild thickening of your mitral valve.
  • Stage B: Progressive. You don’t have any symptoms yet, but problems have begun to get more serious, such as moderate to severe mitral valve prolapse.
  • Stage C: Asymptomatic severe. You still have no symptoms, but your mitral valve prolapse has become severe and your mitral valve can no longer close fully.
  • Stage D: Symptomatic severe. It is similar to stage C, but now you have symptoms during physical activity, such as shortness of breath

The answer is different for different people. It can be a slow-moving disease, or it can get worse more quickly. Doctors can tell how far your disease has progressed by measuring how much blood leaks through your mitral valve. How well you will do depends on a few different factors, including:

  • The cause of your mitral valve regurgitation
  • The stage of your disease
  • The severity of your disease
  • How long you have had mitral valve regurgitation

If you have a mild case, you might need no treatments at all. Your doctor will still want to keep a watchful eye on you with regular checkups. Here’s a likely follow-up schedule:

  • If you have a mild case, expect to undergo an echocardiogram test every 3-5 years.
  • If you have a moderate case, you should have an echo every year or two.
  • If you have a severe case, you should see your doctor at least every 6-12 months.

Medications

Medications can’t actually fix a valve problem, but they can target other things that make regurgitation worse or conditions that arise as complications of your mitral valve regurgitation. These include:

  • Diuretics (or “water pills”) increase the amount that you pee. This helps relieve fluid buildup that can develop in your lungs.
  • Angiotensin-converting enzyme (ACE) inhibitors relax your arteries and veins, lowering your blood pressure. They also lower the amount of blood that leaks back into your left atrium.
  • Anticoagulants (or blood thinners) prevent clots from forming and lower your risk of stroke if you have atrial fibrillation.

In more severe cases, you might need an operation.

 

Not everyone with mitral valve regurgitation will require surgery, but if your disease doescontinue to get worse over time, a procedure may become necessary. The decision about whether to fix it and what type of procedure to use depends on several things:

  • The severity of your valve problem
  • Your age and health
  • Whether you need surgery for other heart conditions

Surgery for mitral valve regurgitation is done to repair or replace your mitral valve. Your surgeon attempts to fix your mitral valve by:

  • Patching holes in your valve.
  • Reconnecting the leaflets of your valve.
  • Removing excess valve tissue to allow your valve to close properly.
  • Replacing the string-like chords that support your mitral valve with artificial chords.
  • Separating the leaflets of your valve if they have become connected.

Specific repair procedures include:

  • Annuloplasty, in which your surgeon tightens or reinforces your mitral valve by permanently placing a flexible mesh, metal, or plastic ring around your valve to help it open and close properly.
  • Valvuloplasty, which is done if your valve has a narrowed opening. Your doctor inserts a catheter into an artery and guides it to your mitral valve. Once there, a balloon is inflated, widening the opening of your valve.
  • Mitral valve clip, also called transcatheter edge-to-edge repair (TEER), in which a catheter is guided to your heart and used to attach a clip to your mitral valve. The clip helps your valve to close properly.

Mitral valve replacement

If your mitral valve can’t be repaired, it will need to be replaced. Your new valve will be either:

  • Mechanical, or made of carbon and steel, which typically lasts 20-30 years, so you may not need a second surgery. However, they increase your risk of blood clots, which require you to take blood thinners for the rest of your life.
  • Biological, made of tissue taken from pigs, cows, or in rare cases humans. These are less durable than mechanical valves and may need replacement after 10-15 years. They don’t raise your risk of blood clots, so you won’t need to take blood thinners.

Replacement surgery usually requires open heart surgery. However, you may qualify for a minimally invasive procedure called transcatheter mitral valve repair or replacement (TMVR). Ask your doctor if this is an option for you.

Open-heart surgery

This is the most common way to repair or replace your heart valve.

You may need it even if you don’t have any symptoms. That’s because your doctor might decide this will prevent long-term heart damage.

Usually, doctors prefer to repair the valve instead of replacing it. It all depends on your particular case, though.

If you get a replacement, the valve may be a man-made device or it could come from a pig, a cow, or someone who signed up for organ donation before they died.

During open-heart surgery, you’ll be given something so you won’t be awake. You will not feel pain during the procedure.

Other types of surgery

Sometimes, doctors will decide someone is too sick to have open-heart surgery. They have other options.

Your doctor could recommend what’s called “minimally invasive heart surgery.” Instead of opening up your chest, your doctor creates one or more small cuts and works through them.

Depending on the kind of procedure, the surgeon may use a robotic arm or a long, flexible tube called a thoracoscope that holds a tiny video camera.

Like open-heart surgery, you’ll be given something so you won’t be awake or feel any pain while it’s going on.

This is a newer field of surgery, so you want to ask your doctor about the experience level of the team and the hospital in doing this type of procedure.

Catheters

Your doctor may not think you’re healthy enough for surgery or that the fix can be made with a procedure that's easier on you. Some hospitals are able to use catheters to repair or replace the valve. Several types of procedures use these small, flexible tubes.

Your doctor inserts the catheter into a blood vessel in your leg and guides it toward your heart. It may hold a clip at the end to repair your valve. Or it may carry a balloon that’s inflated at the right spot to make room for a replacement valve.

During these procedures, you are given something to help you stay calm, but you may be awake.

Before and after your hospital stay

It’s a good idea to plan for your first week of meals before you go into the hospital. You can make them ahead of time and freeze them. That makes it easy for a relative or friend to warm up the food for you.

Arrange for someone to drive you to and from the hospital while you’re recovering.

Ask someone to listen to the doctor’s instructions when you’re sent home from the hospital. You may not be thinking as clearly as normal because of the surgery. You may even want to consider home health care during the early stages of your recovery.

You’ll need to remember the medication and the proper doses you need to take after surgery. Use a chart or tracker to help you keep up your schedule.

No matter what stage your regurgitation is at, there are things you can do at home to manage it. Your doctor may bring up many of the following:

  • Keep your appointments. You need to make your health a top priority. That means putting visits to your doctor at the top of your to-do list. 

  • Eating well. You need to eat lots of fruits, vegetables, whole grains, and proteins. You’ll need to limit salt, added sugars, saturated and trans fats, and alcohol. Your doctor may recommend what’s called the “Dietary Approaches to Stop Hypertension” diet, or DASH.

  • Exercise. It plays a big role in managing many types of heart disease. You’ll need to talk to your doctor about what kinds of physical activity are safest for you. Your doctor might recommend at least 2.5 hours of moderate-intensity aerobic exercise every week and a limit on the amount of sitting you do.

  • Stress. It’s important to learn how to cope with stress in a healthy way. Stress can trigger a heart attack or chest pain in some people. Medication (prescribed by a doctor), exercise, and relaxation therapy are a few ways to reduce tension.

  • Smoking. It increases your risk for heart attacks and worsens regurgitation. If you are a smoker and have trouble quitting, talk to your doctor about ways you can break the habit.

Support groups

You may find you need help in learning to live with this condition. Maybe you just need someone to talk to.

There are support groups that can help you handle the emotional side of a diagnosis. Family and friends are often a good place to turn to for support.

You can also ask your doctor about other support options in your city. They often have people on staff who can help to get you started.

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