Mitral regurgitation is a condition in which the mitral valve does not close properly, allowing blood to flow backward from the left ventricle into the left atrium during systole. If left untreated, it can lead to cardiac dilation, arrhythmias, and heart failure.

 

What is the Mitral Valve?

The mitral valve is one of the four heart valves and separates the left atrium from the left ventricle. Its job is to ensure one-way blood flow during the cardiac cycle.
When it loses its ability to seal completely, mitral regurgitation occurs.

 

Types of Mitral Regurgitation

1. Primary (Degenerative) Mitral Regurgitation

Caused by a structural abnormality of the valve:

• Mitral valve prolapse

• Chordae tendineae rupture

• Mitral annular calcification

2. Secondary (Functional) Mitral Regurgitation

The valve itself is structurally normal, but the problem results from left ventricular dysfunction:

• Ventricular dilation (post-infarction, cardiomyopathies)

• Papillary muscle dysfunction

 

Symptoms

Early stages may be asymptomatic. Over time, patients may experience:

• Fatigue and reduced exercise tolerance

• Shortness of breath (with exertion or at rest)

• Palpitations (possible atrial fibrillation)

• Peripheral edema

• Nocturnal dyspnea

 

Common Causes

• Mitral valve prolapse

• Myocardial infarction

• Dilated cardiomyopathies

• Rheumatic fever

• Age-related degeneration

• Infective endocarditis

 

Diagnosis

Diagnosis is based on:

Cardiology consultation

A characteristic systolic murmur may be heard on auscultation.

Transthoracic Echocardiogram (TTE)

The key diagnostic tool:

• Evaluates the degree of regurgitation

• Assesses left ventricular size and function

• Analyzes leaflet and chordal structure

Additional tests (when needed)

• Transesophageal echocardiogram (TEE)

• Cardiac MRI

• Exercise testing

• Holter ECG monitoring

• Cardiac catheterization (selected cases)

 

Severity Grading

Mitral regurgitation is classified as:

• Mild

• Moderate

• Severe

The severity guides treatment decisions and timing.

 

Treatment

Therapy depends on:

• Type (primary vs. secondary)

• Severity

• Symptoms

• Left ventricular function

1. Medical Therapy

Does not “fix” the valve, but helps manage symptoms — especially in functional MR:

• Diuretics

• ACE inhibitors / ARNI

• Beta-blockers

• Medications for atrial fibrillation (when present)

2. Surgical Treatment

Indicated in severe cases or when left ventricular changes appear.

Options include:

• Valve repair (preferred when feasible)

• Valve replacement (biological or mechanical)

3. Percutaneous (Transcatheter) Options

For patients at high surgical risk:

• MitraClip® (edge-to-edge repair)

• Transcatheter annuloplasty

• New-generation edge-to-edge systems

 

Prognosis

Prognosis depends on:

• Timeliness of diagnosis

• Severity of regurgitation

• Appropriate treatment

Early management often prevents irreversible cardiac damage and preserves quality of life.

 

When to See a Cardiologist

A cardiology evaluation is recommended if you experience:

• Shortness of breath or reduced exercise capacity

• Frequent palpitations

• A previously known heart murmur

• Family history of mitral valve prolapse

 

Conclusion

Mitral regurgitation is common but can be effectively managed today with a wide range of treatment options, from regular monitoring to minimally invasive procedures. Early diagnosis and ongoing follow-up are essential to protect heart function and ensure long-term well-being.