Mitral valve regurgitation

Leaky mitral valve (mitral regurgitation).

In mitral valve insufficiency, the mitral valve is no longer tight due to a weakening. As a result of this inability to close, there is excessive backflow of blood with volume loading of the left atrium, the development of heart failure and even pulmonary oedema.

Anatomy and disease of the mitral valve Causes of mitral valve insufficiency Symptoms and complaints of mitral valve disease Examination and diagnosis of the mitral valve Catheter-based reconstruction of the mitral valve (MitraClip) Surgical reconstruction of the mitral valve Surgical replacement of the mitral valve

Anatomy and disease of the mitral valve

The mitral valve sits between the left atrium and the left ventricle. It prevents the backflow of blood from the left ventricle into the left atrium of the heart during (systole) where it is closed. During the relaxation and filling phase (diastole), the valve is open and allows the chamber to fill.

The mitral valve consists of two delicate, connective tissue leaflets. The leaflets of the mitral valve are attached to the papillary muscles facing the ventricle by tendon threads.

The valve leaflets passively lay flush against each other when the pressure in the left ventricle increases. The papillary muscles prevent the mitral valve from flipping over into the left atrium by pulling on the chordae synchronously with the contraction of the ventricle.

The narrowing of the opening located between the valve leaflets causes what is most common in rheumatic valve disease. The leaky valve leads to loss of closing ability and causes mitral valve regurgitation.

A systolic protrusion of the mitral valve into the left atrium is called mitral valve prolapse, which often does not cause any symptoms and does not need to be treated.

Causes of mitral valve insufficiency

The causes of mitral valve regurgitation are varied: they range from age-related changes in the tissue (e.g. thickening or lengthening) to congenital tissue defects with subsequent tissue prolapse to calcifications, inflammations and changes in the size and function of the left ventricle.

The course of the disease in patients with mitral valve regurgitation depends on the extent of the leakage and the pumping function of the left ventricle. The insufficient valve closure often remains undetected and thus untreated for many years. A healthy organism can often compensate for this weakness over decades.

However, there is a progressive increase in the size of the left atrium and the left ventricle associated with a deterioration in the pumping function of the heart.

Symptoms and complaints of diseases of the mitral valve

Symptoms and complaints of mitral valve disease

The signs and symptoms of mitral valve disease depend on how advanced the stenosis or insufficiency is. Often, the diseased mitral valve causes few or no symptoms. Mild forms of mitral regurgitation are present in many patients and usually cause no symptoms.

Once the symptoms appear, more severe disabilities occur within a few years. Patients may then suffer from shortness of breath even at rest.

The most prominent symptoms of diseased mitral valves include:

General reduction in performance
Shortness of breath (dyspnoea), mostly dyspnoea on exertion
Cough or irritation of the cough
Acute pulmonary edema
Small, rusty brown blood inclusions (haemoptysis) in the cough sputum
Tachycardic atrial fibrillation with risk of embolism and stroke

Examination and diagnosis of the mitral valve

If a disease of the mitral valve is suspected, the doctor will perform a physical examination, including blood pressure measurement. With the stethoscope, a high-frequency heart murmur can often be heard during the ejection phase of the heartbeat in the case of mitral valve insufficiency.

The apparative diagnosis also includes examinations by means of ECG (electrocardiogram) and X-ray of the chest. An ultrasound examination of the heart (echocardiography) is crucial for the diagnosis. This also allows quantification of the severity and the effects (pulmonary pressure increase, enlarged heart cavities, etc.). In many cases, an echocardiogram through the esophagus (transesophageal echocardiography) is also performed in order to see the mitral valves in higher resolution and to discuss possible treatment options.

A cardiac catheter examination with coronary angiography completes the diagnosis before surgical intervention in order to exclude diseases of the coronary vessels that require treatment.

Catheter-based reconstruction of the mitral valve (MitraClip)

MitraClip valve repair is a catheter-based procedure to correct severe mitral regurgitation. A catheter is inserted into the left atrium through an access point in the inguinal vein.

This allows the placement of one or more "MitraClips" between the anterior and posterior leaflets of the mitral valve. The "MitraClips" work like paper clips, attaching the free edges of the valve to the sites of leakage, thus reducing mitral regurgitation.

The procedure is performed on the beating heart, advantages are low complication rate and quick recovery time.

Catheter-based reconstruction of the mitral valve (MitraClip)

Surgical reconstruction of the mitral valve

Surgical reconstruction of the mitral valve becomes necessary in the case of a leaky (insufficient) valve. Only the optimal interaction of the four components of the mitral valve - two leaflets, suspension of the leaflets in the valve ring, tendon sutures and papillary muscles - guarantees a perfect opening and tight closure of the mitral valve.

The most important advantage of valve reconstruction is the preservation of the patient's own natural valve. With a stable rhythm, the use of anticoagulant medication can be dispensed with in the long term.

Surgical reconstruction of the mitral valve

Surgical replacement of the mitral valve

Surgical mitral valve replacement is mainly performed in cases of stenosis of the mitral valve. The operation is usually performed in a minimally invasive procedure without opening the entire sternum and with the use of the heart-lung machine. The altered valve is carefully removed through the opened left atrium and replaced by a biological or mechanical valve prosthesis.

Surgical replacement of the mitral valve

Catheter-based reconstruction (MitraClip) for insufficiency of the mitral valves

Catheter-based heart valve therapies have established themselves as an alternative to conventional surgical treatment of heart valves. In particular, seriously ill patients and those who are not suitable for surgical intervention can nowadays be treated successfully thanks to the latest technology.