Mitral Valve Regurgitation (Leaky Mitral Valve)

Overview of Mitral Valve Regurgitation

Mitral valve regurgitation is also widely known as mitral regurgitation (MR), but are often called other names like:

• Leaky mitral valve
• Mitral valve insufficiency
• Mitral insufficiency
• Mitral valve incompetence

The Keyhole Heart Clinic, based in London and Nottingham, is on hand to provide you with all the advice you need.

Read our guide to learn more about this heart valve disease, including what causes mitral valve regurgitation, symptoms and treatment options.

What Is Mitral Valve Regurgitation?

The Mitral Valve is located in the left lower heart chamber on the left side of the heart. Regurgitation means the mitral valve in your heart isn’t closing tightly, allowing blood to leak backward into the left chamber instead of moving forward. 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. Acute mitral valve regurgitation may also develop when the disease develops quickly.

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 blood pressure in the lung vessels (pulmonary hypertension).

The good news is that mitral valve regurgitation and be treated. With early intervention – especially using modern minimally invasive techniques – a leaky valve can be corrected and your heart function improved before permanent damage occurs.

MR is generally classified into two types: primary and secondary, depending on the underlying cause.

Primary Mitral Regurgitation

Primary mitral valve regurgitation, also called degenerative or organic mitral regurgitation, is caused by physical abnormalities of the mitral valve itself. Structural issues directly compromise the valve’s ability to maintain one-way blood flow.

Secondary Mitral Regurgitation

Also known as functional or ischemic mitral regurgitation, this type occurs despite the valve structure remaining intact. The problem lies in changes to the shape or function of the left ventricle. These changes can prevent the valve leaflets from meeting properly, which leads to backwards leakage of blood into the left atrium.

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 leaky mitral valve symptoms 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.
• Rapid breathing: Breathing faster than normal may indicate your heart is compensating.

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, coronary artery disease 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 – please see a doctor. Identifying a leaky valve early allows for timely treatment and better outcomes.

Mitral Regurgitation Valve Causes

Your heart has four valves that keep the blood flowing consistently in the correct direction. 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.

The most common causes of mitral valve regurgitation include:

• 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 – heart tissue cords that anchor the leaflets to the heart muscle may stretch or tear, causing a mitral valve leak.
• Rheumatic fever – a complication of untreated strep-throat infection in early life that could damage the mitral valve, causing regurgitation later in life. When mitral valve damage results from rheumatic fever, it’s called rheumatic heart disease.
• 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.
• Cardiomyopathy – when the heart muscle becomes abnormally thick (hypertrophic cardiomyopathy) or stretched and weakened (dilated cardiomyopathy), the heart may struggle to pump blood efficiently.

Diagnosis of Mitral Regurgitation

Diagnosing mitral valve regurgitation typically involves a few steps.

1. 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.
2. 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 backwards, while also checking if the heart chambers are enlarged or under strain.
3. 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).
4. 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 mitral valve regurgitation diagnosis, 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 valve regurgitation can lead to complications, including:

• Atrial fibrillation: While atrial fibrillation 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, this will lead to a stroke.
• Heart failure: Congestive heart failure can happen when your heart can’t pump enough blood to meet your body’s needs. Severe mitral valve 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.

Mitral Valve Regurgitation Treatment

Treatment for mitral valve regurgitation depends on risk factors, 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 & Medications

Heart problems present differently throughout the course of your life. If you have a mild, leaky mitral valve and you’re not experiencing symptoms, we may recommend regular monitoring rather than immediate intervention. This watchful waiting approach helps us track your heart health over time and detect any changes early.

We’ll schedule periodic echocardiograms to assess how well your valve is functioning and how your heart is coping.

Medications may be used to manage related issues and improve your quality of life. These might include:

• Blood pressure medications such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors (relax blood vessels) and calcium channel blockers (improve blood flow)
• Diuretics to relieve fluid buildup in the lungs
• Drugs to manage irregular heart rhythms, such as atrial fibrillation
• Blood thinners to help prevent blood clots, particularly if abnormal heart rhythms are present

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 mitral valve opens and 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) Heart Valve Surgery

At The Keyhole Heart Clinic, mitral valve replacement or repair 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.

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. 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 undergoing 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.

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.

Help your family and friends better understand mitral valve regurgitation causes and treatment with our easy-to-follow video library. You should focus on feeling supported, not explaining.

FAQs on Leaking Mitral Valves

Explore our expert answers to frequently asked questions about mitral valve regurgitation.

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, 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 just 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 or chronic.

1. Acute mitral regurgitation where the valve suddenly becomes leaky and the heart does not have time to adapt.
2. Chronic mitral regurgitation where the valve gradually becomes leakier over time, and may allow the heart time to adapt.

Have more questions or need advice about mitral valve regurgitation? Contact The Keyhole Heart Clinic at +44 (0)20 8079 7860.

The Keyhole Heart Clinic: Heart Experts You Can Trust.

Our team at The Keyhole Heart Clinic has pioneered minimally invasive cardiac surgery techniques. The clinic is led by Mr. Inderpaul Birdi, an expert in cardiovascular medicine with over 20 years of experience in keyhole surgery.

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.

In addition to keyhole mitral valve repair surgery, our surgical offering includes:

• Keyhole coronary bypass surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial fibrillation ablation
• Keyhole atrial septal defect closure

Book your in-person or virtual consultation to discuss your options regarding mitral valve regurgitation. Let us help you take the next step toward a healthy heart and peace of mind.