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) doesn't 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 don't 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.
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.
BOOKS
McGoon, Michael D., Mayo Clinic Heart Book: The Ultimate Guide to Heart Health. New York: William Morrow and Co., Inc., 1993.
PERIODICALS
Ling, Lieng H., et al. "Clinical Outcome of Mitral Regurgitation Due to Flail Leaflet." New England Journal of Medicine 335 (7 Nov. 1996): 1417+
