Mitral Valve Disease – Mitral Regurgitation

What is Mitral Regurgitation?

Mitral Regurgitation also known as MR, means the the mitral valve is leaky. That means normally blood should go from the left atrium to the left ventricle and not in the reverse direction. But what happens when this leaflet or the mitral valve is not normally functioning the blood leaks back from left ventricle into the left atrium so this problem is called mitral regurgitation.

How can Mitral Regurgitation be diagnosed?

This leaky valve or mitral regurgitation can be easily identified by performing a clinical examination that means using a stethoscope one can find there is a mitral regurgitation is there or not. The confirmatory test for mitral regurgitation is by doing an echocardiography with colour doppler. So colour doppler means we can identify the blood cells which are leaking from the left ventricle to the left atrium that can be seen in a different colour on the echocardiography machine.

• Clinical Examination

Echocardiography – Colour Doppler examination

• Cardiac Magnetic Resonance Imaging (MRI)

What are the symptoms of Mitral Regurgitation?

The usual symptoms of a mitral regurgitation are most of the patients do not experience any symptoms until the disease is advanced. So patients with mitral regurgitation they develop symptoms quite late in the disease history. That means usually they develop symptoms at 10 years or 15 years after the development of mitral regurgitation. So the initial course of the illness the patient does not experience any symptoms.

Even at the end of 10 years also most of the time because there is a lot of blood coming from the left atrium to the left ventricle. That means the blood which is normally coming and the blood which is leaking and coming back again leads to increase in size of the left ventricle as well as in the left atrium. So when there is more blood which is coming to the heart then what happens is the patient perceives it as palpitation or excessive heart beating. Only when the disease is severe and the heart pumping is reduced then patients will develop breathlessness in mitral regurgitation. So mitral regurgitation in contrast to patients with a narrowed valve.

• No symptoms for the initial 10-15 years of illness
• Palpitations
• Breathlessness in advanced stages of disease

How do symptoms differ between a leaky versus narrowed mitral valve?

A leaky valve is mitral regurgitation and a narrowed valve is mitral stenosis. A leaky mitral valve (Mitral Regurgitation or MR) usually does not have any symptoms or may present with palpitations. Where as A narrowed valve or a stenosed valve (Mitral Stenosis or MS) usually presents with breathlessness.

So that is how the patients with mitral regurgitation and mitral stenosis even though both are diseases of the mitral valve they present with different symptoms.

What are the complications of long standing Mitral Regurgitation?

Complications of mitral regurgitation in the initial phase are usually not there. The early stages of mitral regurgitation because the problem is more of leaking of the valve the heart is able to tolerate the increased volume of blood which is coming to the left ventricle. But when the left ventricles capacity reaches a particular point and the ventricle cannot compensate for this increased volume that is when the patient starts experiencing some problems.

Usually what happens is there will be enlargement of the left ventricle which can lead to a dysfunction of the left ventricle that means with progression of the mitral regurgitation the left ventricular function is reduced.

The other problem what can happen is because there is a leaking of the blood from the left ventricle to the left atrium there will be an increase in the size or enlargement of the left atrium. So the enlargement of the left atrium leads to a problem called as atrial fibrillation. So there could be a ventricular dysfunction or heart failure or there could be an enlargement of the atrium leading to atrial fibrillation or an irregular chaotic heart beating.

The other problem which can happen with mitral regurgitation is the pressure of left ventricle and left atrium gets transmitted to the right side of the heart. So that can lead to a a problem called as the pulmonary hypertension and consequent right ventricular or the right sided lower chamber dysfunction or poor ability of the functioning of the right side ventricle.

So the major complications of mitral regurgitation are left ventricular dysfunction, atrial fibrillation, right ventricular dysfunction and pulmonary hypertension or increase in the blood pressure within the lungs. So all these complications indicate the disease has advanced to such a stage that this patient requires an early surgery for the mitral valve.