Mitral Valve Insufficiency


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Mitral Valve Insufficiency

 

Definition

Mitral valve insufficiency is a term used when the valve between the upper left chamber of the heart (atrium) and the lower left chamber (ventricle) does not close well enough to prevent back flow of blood when the ventricle contracts. Mitral valve insufficiency is also known as mitral valve regurgitation or mitral valve incompetence.

Description

Normally, blood enters the left atrium of the heart from the lungs and is pumped through the mitral valve into the left ventricle. The left ventricle contracts to pump the blood forward into the aorta. The aorta is a large artery that sends oxygenated blood through the circulatory system to all of the tissues in the body. If the mitral valve is leaky due to mitral valve insufficiency, it allows some blood to get pushed back into the atrium. This extra blood creates an increase in pressure in the atrium, which then increases blood pressure in the vessels that bring the blood from the lungs to the heart. Increased pressure in these vessels can result in increased fluid buildup in the lungs.

Causes and symptoms

In the past, rheumatic fever was the most common cause of mitral valve insufficiency. However, the increased use of antibiotics for strep throat has made rheumatic fever rare in developed countries. In these countries, mitral valve insufficiency caused by rheumatic fever is seen mostly in the elderly. In countries with less developed health care, rheumatic fever is still common and is often a cause of mitral valve insufficiency.
Heart attacks that damage the structures that support the mitral valve are a common cause of mitral valve insufficiency. Myxomatous degeneration can cause a "floppy" mitral valve that leaks. In other cases, the valve simply deteriorates with age and becomes less efficient.
People with mitral valve insufficiency may not have any symptoms at all. It is often discovered during a doctor's visit when the doctor listens to the heart sounds.
Both the left atrium and left ventricle tend to get a little bigger when the mitral valve does not work properly. The ventricle has to pump more blood so it gets bigger to increase the force of each beat. The atrium gets bigger to hold the extra blood. An enlarged ventricle can cause palpitations. An enlarged atrium can develop an erratic rhythm (atrial fibrillation), which reduces its efficiency and can lead to blood clots forming in the atrium.

Diagnosis

When the doctor listens to the heart sounds, mitral valve insufficiency is generally recognized by the sound the blood makes as it leaks backward. It sounds like a regurgitant murmur. The next step is generally a chest x ray and an electrocardiogram (ECG) to see if the heart is enlarged. The most definitive noninvasive test is echocardiography, a test that uses sound waves to make an image of the heart. This test gives a picture of the valve in action and shows the severity of the problem.

Treatment

A severely impaired valve needs to be repaired or replaced. Either option will require surgery. Repairing the valve can fix the problem completely or reduce it enough to make it bearable and prevent damage to the heart. Valves can be replaced with either a mechanical valve or one that is partly mechanical and partly from a pig's heart.
Mechanical valves are effective but can increase the incidence of blood clots. To prevent blood clots from forming, the patient will need to take drugs that prevent abnormal blood clotting (anticoagulants). The valves made partly from a pigs heart do not have as great a risk of blood clots but don't last as long as fully mechanical valves. If a valve wears out, it must be replaced again.
Damaged heart valves are easily infected. Anytime a procedure is contemplated that might allow infectious organisms to enter the blood, the person with mitral valve insufficiency should take antibiotics to prevent possible infection.

Prognosis

The diagnostic, medical and surgical procedures available to the person with mitral valve insufficiency are all likely to produce good results.

Key terms

Aorta — A large artery beginning at the base of the left ventricle.
Atrium — One of the two upper chambers of the heart.
Rheumatic fever — An illness that sometimes follows a streptococcal infection of the throat.
Ventricle — One of the two lower chambers of the heart.

Prevention

The only possible way to prevent mitral valve insufficiency is to prevent rheumatic fever. This can be done by evaluating sore throats for the presence of the bacteria that causes strep throat. Strep throat is easily treated with antibiotics.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

Other

The Meck Page. http://www.merck.com.

Patient discussion about Mitral Valve Insufficiency

Q. what do you do with a broken heart? I HAD A ECHO DONE THIS WEEK AND CONCLUSION WAS: 1)SEVERE MIRTAL REGURGITATION WITH LEFT ATRIAL DILATATION 2)LOW NORMAL LV FUNCTION CHEST X RAY IMPRESSION WAS: 1)NORMAL SIZE HEART WITH PROMINENT LEFT HEART BORDER. 2)PROMINENT MARKINGS WITH PROMINENT CHANGES. 3)THE BONES ARE OSTEOPENIC. BLOOD TEST....CHEMISTRY B TYPE NATRIURETIC PEPTIDE HIGH 260

A. The left atrial dilatation is likely the cause of the elevated beta natriuretic peptide. A cardiologist should be able to talk with you about dealing with the mitral valve regurgitation.

More discussions about Mitral Valve Insufficiency
References in periodicals archive ?
As with mitral valve insufficiency, when the heart's left ventricle can't adequately pump blood to the body, the blood can back up into the lungs and ultimately lead to congestive heart failure.
We presented the incidental diagnosis of myxoma from left and right femoral embolectomy material in a 76-year-old female patient with left atrial thrombus mimicking left atrial myxoma concomitance with rheumatic mitral valve insufficiency.
Weakness, shortness of breath, excessive perspiration and nausea are common symptoms of mitral valve insufficiency, which is sometimes congenital but may also be caused by tissue overgrowth, infection or damage from heart attacks.
Currently, not all potential patients with mitral valve insufficiency consider surgery as a treatment option since the necessary surgery would be "open-heart," invasive, and expensive.
We think Myocor has what it will take to become the standard of care for mitral valve insufficiency," said Gordie Nye, general partner at Prism Venture Partners.
designs, develops and manufactures less invasive, implantable devices that utilize shape change technology to treat cardiac diseases such as mitral valve insufficiency and congestive heart failure.
designs, develops, and manufactures less invasive, implantable devices to treat mitral valve insufficiency and congestive heart failure.

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