Mitral Valve Regurgitation (Leaky Mitral Valve)

We understand that being diagnosed with a heart condition, such as mitral valve regurgitation, can be daunting, which is why we have put together this guide to help you learn more. If you have been looking for more information about mitral regurgitation, mitral valve regurgitation symptoms, and the best course of action for mitral regurgitation treatment, The Keyhole Heart Clinic (based in London, Essex and Nottingham) are on hand to provide you with all of the advice you need.

What Is Mitral Valve Regurgitation?

Mitral valve regurgitation, also known as a “leaky mitral valve,” means the mitral valve in your heart isn’t closing tightly, allowing blood to leak backward into the left atrium instead of moving forward to the body. When the leak is mild, your heart may compensate and you might not notice any issues. However, a significant mitral valve leak can reduce blood flow to your body, leading to symptoms like shortness of breath and fatigue. Over time, an untreated leaky mitral valve puts strain on the heart and lungs, potentially causing complications such as an enlarged left atrium, atrial fibrillation (irregular heartbeat), or high pressure in the lung vessels (pulmonary hypertension). The good news is that mitral regurgitation is treatable. With early intervention – especially using modern minimally invasive techniques – a leaky valve can be corrected and your heart function improved before permanent damage occurs.

At The Keyhole Heart Clinic, we specialise in minimally invasive mitral valve surgery (also known as keyhole heart surgery). Our experienced team is here to guide you through understanding your diagnosis and choosing the best treatment. Below, we cover the symptoms, diagnosis, and treatment options – including why keyhole surgery may be the best solution – so you can make informed decisions with confidence.

Symptoms of Mitral Valve Regurgitation

Mitral valve regurgitation often develops gradually, and you may not notice any problems at first. When symptoms do appear, it’s because blood is backing up into the lungs and the heart is working harder to push blood forward. Common symptoms of a leaky mitral valve include:

• Shortness of breath: Trouble breathing, especially when lying flat or during activity.
• Fatigue/weakness: Feeling unusually tired or weak.
• Heart palpitations: Sensation of a rapid or irregular heartbeat (sometimes due to atrial fibrillation).
• Swelling (oedema): Fluid buildup in the ankles, feet, or abdomen.
• Chest pain: Chest discomfort or pressure, especially with exertion.

Mild mitral regurgitation may cause no symptoms for a long time. In some cases, symptoms come on suddenly if the valve leak develops quickly (for example, due to a heart attack or a ruptured valve cord). If you notice any of the above signs – or if you experience ongoing shortness of breath or fatigue without a clear cause – see a doctor. Identifying a leaky valve early allows for timely treatment and better outcomes.

Causes of Mitral Regurgitation

Your heart has four valves that keep the blood flowing consistently in the correct direction, and these are the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Each of these valves has flaps, otherwise known as leaflets or cusps, that open and close once during each heartbeat. If they don’t open or close properly, the blood flow can be disrupted.

Mitral valve regurgitation can be caused by various problems, such as:

• Mitral valve prolapse – a common heart issue where the mitral leaflets bulge back into the left atrium during contractions, preventing the valve from closing tightly.
• Damaged tissue cords – tissue cords that anchor the leaflets to the heart muscle may stretch or tear, causing a mitral valve leak.
• Rheumatic fever – this complication of untreated infection in early life could damage the mitral valve, leading to regurgitation later in life.
• Heart attack – this can damage the area of the muscle that supports the valve, affecting its function.
• Congenital heart defects – it is possible to be born with damaged heart valves.
• Endocarditis – the valve may be damaged by an infection of the lining of the heart.
• Atrial fibrillation – atrial fibrillation is a common heart rhythm problem that can be a potential cause of mitral or tricuspid valve regurgitation.

Diagnosis of Mitral Regurgitation

Diagnosing mitral valve regurgitation typically involves a few steps. First, your doctor will talk to you about your symptoms and medical history, and listen to your heart. A heart murmur (an abnormal whooshing sound) heard through a stethoscope can be an initial clue. The key test for confirming a leaky mitral valve is an echocardiogram – an ultrasound of the heart. An echo shows the mitral valve in motion and measures how much blood is leaking backward, while also checking if the heart chambers are enlarged or under strain.

Your doctor might also order other tests to get a complete picture, such as an electrocardiogram (ECG) to check your heart rhythm, a chest X-ray to see if the heart is enlarged or if there is fluid in the lungs, or a cardiac catheterisation (angiogram) to examine the coronary arteries and heart pressures (especially if surgery is planned).

If there is any doubt regarding the severity of the leak, then a test such as stress echocardiography (either medically induced or during mild exercise) is very valuable. Early surgery should certainly be performed if repair of the valve is possible, since this is far superior to replacement. If the valve is not repairable, then replacement should be considered when symptoms develop, or if there is evidence of heart enlargement, atrial fibrillation, or pulmonary hypertension.

At The Keyhole Heart Clinic, we provide comprehensive heart evaluations using the latest technology. Once we confirm a diagnosis of mitral regurgitation, we’ll explain how severe it is and discuss what that means for your treatment plan.

Potential Mitral Regurgitation Complications

When it is mild, mitral valve regurgitation usually does not cause any problems. However, severe mitral regurgitation can lead to complications, including:

• Atrial fibrillation – while this is a cause of regurgitation, it can also be a future complication. The stretching and enlargement of the left atrium may lead to this heart rhythm irregularity, causing blood clots that can travel to other parts of the body. In the brain, a stroke is the result.
• Heart failure – this can happen when your heart can’t pump enough blood to meet your body’s needs. Severe regurgitation places more strain on your heart and if the left ventricle continues to stretch without treatment, the heart could fail.
• Pulmonary hypertension – if you have untreated regurgitation, you could develop high blood pressure that affects the lung vessels. A mitral valve leak can increase pressure in the left atrium, which can eventually lead to pulmonary hypertension.

Treatment Options in Mitral Valve Regurgitation

Treatment for mitral valve regurgitation depends on the severity of the leak and how it’s affecting your health. Our priority is to manage the condition in the least invasive way that still protects your heart.

Monitoring and Medications:

If your mitral regurgitation is mild and you feel well, we may recommend watchful waiting with regular check-ups. We’ll monitor your heart function with periodic echocardiograms. In the meantime, medications can help control symptoms or underlying issues. For example, drugs to lower blood pressure or reduce fluid buildup (diuretics) can ease strain on the heart and lungs. You might also need medication to manage an irregular heartbeat if one develops (such as atrial fibrillation). These medicines won’t cure the leaky valve, but they can improve how you feel and help prevent complications while we keep a close eye on your condition.

Mitral Valve Repair or Replacement:

If the leak is severe or you’re experiencing significant symptoms, fixing the valve is usually the best course of action. Intervening at the right time can prevent long-term damage to your heart and improve your quality of life. Whenever possible, a mitral valve repair is the preferred surgical solution. Repair means the surgeon mends your existing valve so it closes properly. This preserves your natural valve and usually provides the best long-term outcome (often without the need for lifelong medications). If the valve is too damaged to repair, a mitral valve replacement will be performed. In a replacement, the faulty valve is removed and a new artificial valve is implanted. If a repair isn’t possible, the valve will be replaced with an artificial valve (mechanical or tissue). We will discuss which option is most suitable for you based on your age, health, and personal preferences, and make sure you understand the benefits and considerations of each.

Minimally Invasive (Keyhole) Surgery:

 At The Keyhole Heart Clinic, mitral valve repair or replacement can often be done with a minimally invasive keyhole approach instead of traditional open-heart surgery. Keyhole surgery is performed through a small incision on the right side of your chest, between the ribs, avoiding the need to cut through the breastbone. For you, this means a smaller scar, less pain, and a faster recovery compared to the conventional approach. Most patients with mitral valve regurgitation are candidates for this less invasive method, and our surgical team will confirm if it’s appropriate for you. We have extensive experience in keyhole heart surgery and strongly recommend this approach when feasible due to its many patient benefits (outlined in the next section).

Transcatheter Mitral Repair (MitraClip):

For patients too high-risk for surgery, a catheter-based procedure can sometimes be used to clip the mitral valve and reduce the leak. This minimally invasive treatment (via a vein in the groin) may improve symptoms in those who cannot undergo an operation. However, for patients who can safely have surgery, a surgical repair is generally more effective. We will advise you if a MitraClip is appropriate in your case.

No matter which treatment path is chosen, you will be cared for by a team of valve specialists. We will answer all your questions and ensure you understand the pros and cons of each option. Our goal is to fix your leaky mitral valve at the optimal time and in the safest way, so you can get back to living a healthy life.

Benefits of Keyhole Mitral Valve Surgery

When surgery is required, opting for a keyhole heart surgery technique (minimally invasive mitral valve surgery) offers many advantages for patients. The benefits of keyhole mitral valve surgery include:

• Small incision, minimal scarring: The procedure is done through a small side incision without breaking the breastbone. You avoid the long chest scar from open-heart surgery, resulting in a much smaller, less visible scar.
• Less pain and faster healing: With no bone cutting, post-operative pain is significantly reduced. Patients are typically more comfortable moving around soon after surgery and heal faster. You can return to daily activities much sooner than with the traditional approach.
• Faster recovery: Patients are often home from the hospital within a week, and you can return to work, exercise, and daily routines much sooner than after open-heart surgery. Plus, because your breastbone isn’t cut, you don’t face the 2–3 month lifting restrictions that come with traditional surgery.

Our team at The Keyhole Heart Clinic has pioneered minimally invasive cardiac surgery techniques. In expert hands, minimally invasive mitral valve repair has the same high success rate as open-heart surgery for fixing the valve problem – and patients recover with less discomfort and interruption to their lives. We will evaluate your case to ensure that a keyhole approach is appropriate for you. For the vast majority of people with isolated mitral valve regurgitation, we believe this technique offers an excellent outcome.

Recovery After Keyhole Mitral Valve Surgery

After a keyhole mitral valve surgery, most patients stay in the hospital for about 4–7 days. By discharge, you can walk and care for yourself. Once home, you may feel tired for a couple of weeks, but you will notice improvement each day. Because no breastbone was cut, you can move around freely and do light activities as soon as you feel up to it, without the usual post-surgery lifting restrictions. Within about 4–6 weeks, many patients return to office work and normal routines.

We will see you for a follow-up appointment a few weeks after surgery to check your incision and perform an echocardiogram, ensuring the valve repair is working well. We may also recommend a gentle cardiac rehabilitation program to help you regain strength safely. Compared to traditional open-heart surgery (where recovery can take 2–3 months due to bone healing), the minimally invasive approach allows you to get back to your life much sooner.

Mitral Regurgitation FAQs

Do I need surgery if I have severe mitral regurgitation but no symptoms?

Yes – if your leak is severe, it’s often best to repair it early (the valve won’t fix itself) even if you feel fine. Waiting until symptoms appear can allow silent damage to your heart. We will advise you on the right timing so your valve is fixed before significant harm occurs.

Is keyhole mitral valve surgery as safe as open-heart surgery?

Absolutely. When minimally invasive mitral valve surgery is performed by experts like the team at The Keyhole Heart Clinic, the procedure has been shown in randomised trials to be at least as safe, and in many ways better than traditional sternotomy – with fewer risks and a faster recovery. Our lead surgeon Mr Inder Birdi has been performing keyhole mitral valve repair and replacement for over 20 years in over 1000 patients and his outcomes are world class.

Can mitral valve regurgitation go away?

No, once the valve is damaged, it is unlikely to repair itself. This condition can either be acute, where the valve suddenly becomes leaky and the heart does not have time to adapt, or chronic, where the valve gradually becomes leakier over time, which may allow the heart time to adapt.

Contact Us:

Have more questions or need advice about mitral valve regurgitation? We’re here to help. If you’d like to discuss your condition or explore your treatment options (including keyhole mitral valve repair), please get in touch. We offer in-person and virtual (online) consultations to suit your needs. Contact The Keyhole Heart Clinic at +44 (0)20 8079 7860 or use our website form to schedule a consultation. Let us help you take the next step toward a healthy heart and peace of mind.