Overview

Mitral valve disease (MVD) is the most common type of heart valve disease. This condition affects the valve between the left heart chambers, preventing it from being able to close properly. 

Blood can leak backwards through the valve, known as mitral regurgitation. A severe leakage can result in insufficient blood moving through the heart or to the rest of the body.¹ 

MVD is typically the result of a mitral valve prolapse, which happens when the flaps of the heart valve begin to sag and lean into the left upper heart chamber. A prolapse of the mitral valve may not always result in the backflow of blood. However, when backflow does occur, it can get worse over time and may lead to an infection or an increase in pressure in the heart and lungs. 

Another type of mitral valve disease is Stenosis, where the opening of the valve is too small, making it difficult for blood to pass through, causing the heart to work harder to pump enough blood throughout the body. 

Pulmonary hypertension is a condition that affects the blood vessels that are found in the lungs.² This condition develops when the pressure inside the lungs is higher than it should be. As a result, the heart has to work harder to pump blood through the lungs, which can cause damage to the heart over time. 

Pulmonary hypertension can be primary or secondary, with primary having an unknown cause and secondary being caused by known risk factors or an underlying condition.³

What is the link between MVD and pulmonary hypertension?

Severe and untreated cases of MVD can cause an increase in pressure in the lungs, which is associated with the development of pulmonary hypertension.⁴ Pulmonary hypertension affects the blood vessels in the lungs as they become tight and narrow when the pressure increases. 

What are the symptoms of mitral valve disease?

The symptoms of MVD can vary depending on the type that you are diagnosed with, and some people may not experience symptoms at all.⁷

Mitral valve prolapse

• Dizziness
• Tiredness
• Breathless
• Irregular heartbeat or heart palpitations
• Mitral regurgitation 

Mitral regurgitation 

• Dizziness 
• Tiredness
• Breathlessness
• Chest pain 

Mitral stenosis 

• Dizziness
• Tiredness
• Chest pain
• Heart palpitations
• Breathlessness

A lot of people who have been diagnosed with mitral valve disease have not experienced any symptoms, and it may only have been detected by a heart scan carried out for other reasons.  

Is mitral valve disease serious?

Yes, mitral valve disease is a serious lifelong condition. However, many people with the disease or a heart valve defect do not experience any symptoms until later in life. If left untreated, mitral valve disease can cause heart failure or other life-threatening complications. 

How is mitral valve disease diagnosed and treated? 

A physical examination and diagnostic testing often carry out the diagnosis of mitral valve disease, some testing may include:

• Echocardiogram (ECG) is a gold standard test in the detection and diagnosis of heart defects.
• Cardiac CT scan where X-ray technology is used to piece together images of your heart to help determine if there are any valve defects.
• Cardiac Catheterisation helps to measure the blood flow and pressure on either side of the heart. 

Treatment of mitral valve disease is typically a method of mitral valve repair, where a specialist physician repairs the valve instead of replacing it. 

A common method of heart valve repair is balloon valvuloplasty (valvotomy) which helps to alleviate the symptoms of stenosis. An expandable balloon is attached to a catheter threaded into a narrow valve and then expanded, stretching the valve open. 

If you have a mitral regurgitation, you may need to undergo a surgical procedure to trim, shape, or rebuild the valve flaps. The surgeon may add a ring of cloth, tissue, or metal around the valve to tighten and narrow it, preventing blood from leaking backwards.⁸ 

If your mitral valve is too damaged to be repaired, then it may need to be replaced. There are two types of mitral valve replacement:  manufactured mechanical and biological valves.

Manufactured mechanical valve

• Made from carbon and titanium 
• Long-lasting (typically last a lifetime)
• Blood thinning medication is required as it poses a risk of blood clots becoming stuck in the valve flaps and hinges.

Biological valve

• They are made from valves or tissue from an animal donor.
• It lasts around 10-20 years before needing to be replaced.
• Less likely to cause blood clots.

It is important to discuss treatment methods with your doctor or a specialist to figure out the best option for you. 

What are the warning signs of pulmonary hypertension?

The symptoms of pulmonary hypertension can be hard to recognise, with people having them for years without being diagnosed. This is because pulmonary hypertension has a lot of symptoms that are similar to other medical conditions. Symptoms of pulmonary hypertension may include:

• Chest pain
• A dry cough 
• Hoarseness
• Breathlessness and wheezing
• Dizziness, nausea or vomiting
• Weakness and fatigue
• Swelling of the feet, legs, or abdomen

The symptoms of pulmonary hypertension get worse over time and usually begin with shortness of breath during regular exercise, which will progress to feeling breathless more often during everyday activities, like climbing the stairs. 

How serious is pulmonary hypertension?

Pulmonary hypertension is a serious condition that can cause damage to the heart and make the heart muscle pump blood and oxygen less efficiently around the body. If left untreated, pulmonary hypertension can cause heart failure, which is when the heart muscle struggles to pump enough blood and oxygen around the body.

There is no cure for pulmonary hypertension, but there are ways to prevent the symptoms from getting worse.

How do you reduce the symptoms of pulmonary hypertension?

Once a person is diagnosed with pulmonary hypertension, the doctor will create a treatment plan depending on the cause and severity of the condition. There are a few different methods of treating and reducing the symptoms of pulmonary hypertension, such as:

Lifestyle changes

• Heart-Health diet by eating less salt to lower your blood pressure and cholesterol levels.
• Physical activity through an exercise program recommended by the doctor.

Medication

• Anticoagulants or blood thinners help prevent blood clots in those who suffer from chronic blood clots in their lungs. This medication can also be used to reduce the effects of pulmonary arterial hypertension and heart failure.⁵
• Digitalis or digoxin helps to control the rate at which blood is pumped around the body.
• Vasodilator therapy helps to relax the blood vessels and lower the blood pressure in the pulmonary artery. This incorporates calcium channel blockers like nifedipine and diltiazem.⁶

Procedures and therapies

• Oxygen therapy helps to increase the oxygen levels in the blood.
• Balloon atrial septostomy decreases the pressure in the right heart chamber which helps to increase the output of blood through the left side of the heart and increases the oxygen levels in the blood. This is done by enlarging a naturally occurring hole that is found between the right and left atria. 
• Balloon pulmonary angioplasty is used to lower the pressure in the pulmonary artery and is used in cases where someone may not be able to undergo a pulmonary endarterectomy.
• Pulmonary endarterectomy is a surgery used to remove blood clots from the inside of blood vessels in the lungs. 

The doctor may recommend treatment for another condition if that is the cause of your pulmonary hypertension. In this case when pulmonary hypertension is a complication for the person being diagnosed with mitral valve disease, then the doctor may recommend mitral valve repair surgery. Research has shown that the treatment for MVD-induced pulmonary hypertension alone is ineffective and may even cause more damage to the left heart chambers and that the surgical corrections of MVD greatly benefit the overall health and reduction of pulmonary hypertension symptoms in the patients. ⁹

Can I live a normal life after surgery?

If the doctor has recommended surgery to repair or replace the mitral valve, they think it is the best option for you. Having surgery to repair your heart valve can:

• Improve your quality of life. 
• Reduce the strain on your heart.
• Reduce the risk of developing further complications, like heart failure.
• Reduce symptoms, giving you more energy for everyday life. 

If the heart valve needs to be repaired or replaced, it will not get better without surgery. One may also put oneself at risk of developing an infection in your heart.¹⁰ Depending on the type of surgery you have, you can normally return to a normal symptom-free life after 6-12 weeks.

Summary

Mitral valve disease is a common condition affecting the mitral valve in the left chamber of the heart. There are three main types: regurgitation, where the valve cannot properly close and allows the blood to leak backwards into the heart chamber. 

Stenosis is caused by the opening of the valve being too tight and narrow, which increases the pressure of the blood flowing through. A mitral valve prolapse happens when the valve flaps become saggy and lean into the chamber, disrupting the flow of blood. 

All types of mitral valve disease are serious and require treatment, if left untreated they can cause complications such as pulmonary hypertension. 

Pulmonary hypertension is a condition that affects the blood vessels inside the lungs. It develops when the pressure inside the lungs is too high. Chronic pulmonary hypertension can put a strain on the heart as it has to work harder to supply the body with blood, potentially causing damage over time.  

Mitral valve disease is known to cause pulmonary hypertension, it cannot be effectively treated by itself, but instead requires the heart valve to be repaired or replaced before symptoms of pulmonary hypertension can be reduced. 

Surgical treatment is recommended to improve the quality of life in individuals with any type of mitral valve disease.  If MVD is left untreated, the symptoms can get worse over time and lead to heart failure, or infection of the heart.