Mitral valve insufficiency

The heart has four valves. These valves ensure that the blood is pumped in the right direction by the heart and that it does not flow back in again.

Valvular heart disease is typically damage to the heart valves that develops over the course of a person’s life. Doctors therefore also speak of acquired heart valve defects. Typically, these only occur in older people because they usually develop due to wear and tear.

Mitral valve insufficiency is the second most common valve defect after aortic valve stenosis. Because the valve between the left atrium and the left ventricle leaks, some of the blood pumped out flows back into the left atrium. There it meets with fresh blood and increases the total amount of blood. Because there is an excessive amount of blood, the heart muscle has to work harder.

To treat mitral valve insufficiency, similar as with aortic valve stenosis a valve prosthesis can be used. In general, however, a mitral valve can be preserved and its function restored.

The heart can often compensate for a mitral valve insufficiency for years without anyone noticing. 

Complaints only occur when the heart muscle is no longer able to pump sufficient blood into the body. As a result, the organs, as well as the heart itself, experience a lack of blood and an undersupply of oxygen.

Symptoms may include the following:

• weakness and reduced performance
• swelling, especially in the lower legs
• irregular, fast or slow pulse rate
• shortness of breath and coughing, especially at night
• chest pain, tightness
• fainting spells

Age-related wear and tear is the main cause of heart valve diseases like mitral valve insufficiency.

Acquired heart valve diseases, such as mitral valve insufficiency due to wear and tear, occur mainly in older people. 

About 13 percent of people 75 and older have problems with a heart valve; men slightly more often than women.

Often, the heart can compensate for a leaking mitral valve over the years or even decades. 

To do this, however, the heart muscle has to work steadily harder. As a result, the heart muscle thickens and the heart grows. If it is continuously overexerted, the changes can no longer revert, but continue to progress.

The thickened heart muscle is no longer as elastic as before, and the heart chambers wear out. The heart becomes weaker. 

The resulting discomfort is first manifested only during physical exertion, but later also while at rest. Life-threatening heart failure can be the result.

Smoking increases the overall risk of cardiovascular disease including mitral valve insufficiency. Quitting smoking is therefore one of the most important preventive measures.

An increased risk of heart valve damage can also occur as a result of inflammation of the inner lining of the heart, known as endocarditis. Endocarditis is usually caused by bacteria. For this reason, people with a congenital valve defect or with a new heart valve are sometimes given an antibiotic as a preventive measure before treatments in the mouth. This kills bacteria that can pass from the mouth into the blood and cause endocarditis.

Doctors can obtain important information about whether a heart valve disease such as mitral insufficiency is present by performing a thorough physical examination and, in particular, by listening to the heart sounds through a stethoscope.

An ultrasound examination of the heart, known as echocardiography, can confirm the diagnosis and reveal how severe the damage to the heart valve is. Sometimes an ultrasound examination through the esophagus is useful. This procedure is known as a transesophageal echocardiography. A tube with an ultrasound probe is inserted up to the level of the heart, allowing for clearer imaging of the heart compared to a conventional ultrasound.

Once heart valve disease has been reliably diagnosed, the physician also determines the person’s general state of health. Only then is the appropriate treatment selected.

These examinations include, for example:

• resting and stress ECG (electrocardiogram of the heart)
• measurement of blood pressure
• blood sampling for a blood count
• X-ray examination, if necessary computed tomography (CT) and magnetic resonance imaging (MRI)

In addition, an examination with a cardiac catheter may be necessary if there is also a suspicion of narrowing of the coronary arteries. A contrast medium is delivered into the coronary vessels via a cardiac catheter, allowing the physician to assess the vessels on the screen.

Several factors determine whether mitral valve insufficiency must be treated and what treatment is appropriate.

In addition to the type of valve damage, the symptoms experienced play an important role in the treatment decision. Age, general state of health, and the personal needs of the patient are also very important.

To treat mitral valve insufficiency, similar as with aortic valve stenosis a valve prosthesis can be used. However, the damaged mitral valve can usually be preserved. In open surgery or with a heart catheter, the function of the valve is restored.

Doctors refer to these types of surgeries as valve reconstruction. In this procedure, the mitral valve can be strengthened somewhat with the patient’s own tissue, for example, from the pericardium. If the valve is no longer properly attached to the heart muscle and leaks as a result, it can be fixed in place with sturdy plastic threads. In addition, a mitral valve that is too wide can be returned to its correct shape through use of a plastic ring. This makes the valve tighter again when it closes.

Another treatment option is to pull together the leaflets of the leaking mitral valve slightly with a small clip made of metal. This sometimes allows the valve to close completely again.

Heart valve surgery is usually followed by rehabilitation (rehab). It helps the patient become accustomed to physical exertion again and gradually increase it. Rehab can also help to improve the patient’s quality of life. Furthermore, during rehab, medications are adjusted and the heart is checked regularly.

After the operation, some people worry about overexerting themselves and thus making the disorder worse again. For this reason, rehab often includes measures such as discussions to help people cope better with the situation. Many people learn to assess themselves better.

A heart valve disease such as mitral valve insufficiency can also be a psychological burden.

Symptoms such as weakness and fatigue can also contribute to an increasingly limited everyday life.

Deciding on a particular treatment can also prove complex and difficult. Questions or uncertainties should therefore be discussed with the attending physician and, if possible, with relatives.

After heart surgery, it is more difficult to cope with stress for some time. It can therefore be useful to talk to relatives and friends early on about who can help in this phase, when, and how.

It is also possible to apply for support from the health insurance, even before the operation, for example, for help with the household.