Overview

The heart comprises valves that help blood flow or normal circulation between the four chambers. These two valves are known as the atrioventricular valve and the semilunar valve. 

The atrioventricular valves comprise mitral (bicuspid valve) and tricuspid valves located between the atriums and ventricles. Whereas, the semilunar valves comprise the aortic and pulmonary valves are located between the ventricles and the arteries.

Composed of the mitral annulus, papillary muscles, anterior leaflet, posterior leaflet and chordal tendineae, the mitral valve functions to ensure that blood flows from the left atrium into the left ventricle during systole, preventing any backflow during diastole.¹

Adequate functioning of the mitral valve is vital for efficient cardiovascular performance, and any abnormalities or dysfunctions can lead to significant health issues. 

Mitral valve disease refers to a congenital or acquired group of conditions that affect the function of the mitral valve and can lead to serious health problems if not managed effectively on time.

Different forms of mitral valve disease

In a normal scenario, the anterior and posterior leaflets or cusps in your mitral valve act together in a rhythm to let the blood flow normally from the left atrium to the left ventricle, the valve also prevents the backflow of the blood. 

However, mitral valve disease causes the leaflets to be less efficient affecting the blood flow all around the body. The main problems that affect the mitral valve are:²

• Mitral valve prolapse: The valve becomes too floppy, because the leaflets become stretchy, preventing proper closure of the valve when it should.
• Mitral valve stenosis: The valve’s cusps become thick, so the valve doesn’t open as wide as it should, so the blood doesn’t flow easily.
• Mitral valve regurgitation: this is also called a leaky valve. Blood flows in the wrong direction due to the leak.

Symptoms of mitral valve disease

The symptoms vary and may depend on the form of the mitral valve disease you have. In some cases, people live with the disease and don’t show any symptoms for years.

• Fatigue
• Palpitation
• Breathlessness
•  Dizziness
•  Chest pain
•  Cough that may sometimes contain blood
•  Irregular heartbeat or arrhythmia
• Swelling of your legs, ankles or feet
• Migraines

Causes of mitral valve disease

There are many causes of mitral valve disease, including the following:³

• Congenital heart defect: Some people are born with mitral valve abnormalities.
• Connective tissue disorders: Some conditions can cause mitral valve problems like Marfan syndrome and Ehlers-Danlos syndrome.
• Endocarditis: Infection of the heart.
• Enlargement of the left ventricle.
• Older age can be a risk factor.
• Radiation therapy: People who have conditions that require radiation in the chest region can also have a higher chance of developing a heart valve problem.
• Rheumatic fever: The heart valve can be damaged if rheumatic fever is left untreated.

Diagnosis

To diagnose mitral valve disease, the healthcare provider will start with the patient's medical history, and physical examination, followed by several diagnostic tests. 

A stethoscope will be used to listen to the murmuring heart sounds, a whooshing sound could indicate a mitral valve problem.

Other diagnostic tests used may include:⁴

• Echocardiogram: It helps diagnose mitral disease and other heart valve conditions. Sometimes a more detailed echocardiogram is required which is invasive and is called a transoesophageal echocardiogram, unlike the standard echocardiogram which is usually done from outside the body.
• Electrocardiogram (ECG or EKG): A simple test to measure the electrical activity of the heart.
• Chest X-ray: A chest X-ray can show if the size of the heart is normal or enlarged, enlargement of the heart can be a sign of some heart valve diseases.
• Cardiac MRI:  It is usually carried out to determine the severity of mitral heart disease.
• Exercise or stress tests: Check your heart while you are doing an exercise like running on the treadmill to determine how your heart responds to exercise.
• Cardiac catheterization: It is not usually done to diagnose mitral valve disease, but it can be used if the other tests are not conclusive. A catheter is inserted into the heart through a blood vessel, a dye is then pumped through the catheter to make the arteries clear on X-ray. This test is commonly used to diagnose coronary artery disease.

Management and treatment

Treatment options for mitral valve disease depend on your symptoms and the condition you have. Some of the treatment options are:³

• Medications: Diuretics, beta-blockers, and calcium channel blockers may be prescribed by your health care professional to ease some of the symptoms like swelling, and high blood pressure, and regulate the heart rate. Blood thinners may also be prescribed to prevent or lower the risk of blood clots.
• Balloon valvotomy: This is used to treat mitral valve stenosis. A catheter with a balloon at the tip is guided into the heart until it reaches the mitral valve. The balloon is then inflated to widen the mitral valve and allow the blood to flow normally.
• Mitral valve repair surgery: This procedure is preferred over valve replacement whenever possible, to avoid complications.
• Mitral valve replacement: This procedure has its risks and complications, but it is sometimes unavoidable. Your provider will explain everything to you in detail before the surgery.
• Percutaneous mitral valve replacement: In some cases where the surgery of valve replacement carries a high risk, the surgeon will put a new valve inside the diseased valve by expanding it.

FAQs

Can you prevent mitral valve disease?

Mitral valve disease can’t be prevented in most cases, but you can lower your risk of developing mitral valve disease by keeping a healthy weight, treating dental infections, and taking antibiotics for strep throat.

If you are pregnant decrease your baby’s chance of developing congenital heart defects by stopping alcohol, smoking, and taking drugs.

How long can you live with mitral valve disease?

The prognosis of mitral valve disease can rely on several factors like the form of mitral heart disease you have, the severity of your condition, the extent of the damage on your heart, and how early you have received your treatment.

Summary

Mitral valve diagnosis and treatment involve a range of medical practices aimed at identifying and managing conditions affecting the mitral valve, such as mitral valve prolapse, regurgitation, and stenosis.

Diagnostic methods primarily include echocardiography, along with other techniques like electrocardiograms (ECG), chest X-rays, and cardiac MRI. Once diagnosed, treatment options depend on the severity and nature of the valve disorder. 

For mild cases, monitoring and medication are prescribed to manage symptoms and prevent complications may suffice. Medications often include diuretics, beta-blockers, calcium channel blockers, and anticoagulants.

In more severe cases, interventional procedures or surgery might be necessary. Minimally invasive techniques such as balloon valvuloplasty can treat stenosis, while mitral valve repair or replacement surgery may be required for significant regurgitation or structural defects.