Mitral Regurgitation also known as mitral insufficiency or mitral incompetence is a disorder affecting the mitral valve of the heart. The cusps or flaps of the mitral valve do not seal tightly in this condition and causes a backflow of blood through the mitral valve from the left ventricle to the let atrium of the heart. The heart valve in this state is referred to as a leaky valve.
An examination of the mitral valve’s anatomy reveals structures such as valve flaps, a ring like structure around the valve cusps, papillary muscles which attach the flaps to the ventricle and prevent them from falling into the atrium and the chordae tendineae or the heart strings which connect the papillary muscles to the valve flaps. A malfunction of any of these structures can be a cause for mitral regurgitation.
One of the most common causes of Mitral Valve regurgitation is the weakening of the connective tissue of the valve. This process is known as myxomatous degeneration of the valve. This condition is caused by a genetic abnormality which manifests itself as a defect of the protein make up of the valve. This causes an elongation or a stretching out of the valve flaps and the chordae tendineae effectively preventing them from closing tightly thereby causing their prolapsed into the atrium. This finally leads to mitral regurgitation.
Other causes of mitral regurgitation include ischemic cardiomyopathy and a dilation of the left ventricle. Ischemic Cardiomyopathy weakens the papillary muscles causing their subsequent displacement leading to mitral regurgitation. Diseases like dilated cardiomyopathy cause dilation of the left ventricle which also leads to Mitral regurgitation
The symptoms of the disease vary with the stage. Most often the condition develops slowly and over an extended time period. Some patients may have the disease but still my not be aware because there wont be any symptoms for even decades. Since the heart is able to compensate for defects in the early stages the development of symptoms is gradual.
Patients with acute mitral regurgitation may exhibit the following symptoms:
- Shortness of breath.
- Pulmonary edema or fluid accumulation in the lungs.
- Orthopnea or shortness of breath while lying flat.
- Paroxysmal nocturnal dyspnea or cardiac asthma, i.e. a condition in which the person is awakened from sleep at night due to shortness of breath.
- Decreased exercise tolerance.
- Swollen feet or ankles.
There are various testing procedures for diagnosing Mitral Regurgitation. The normal protocol involves the doctor conducting various tests and abnormal results are obtained in case of Mitral Regurgitation. In this case the doctor prescribes more tests for confirmation. Electrocardiogram is the basic test and it may sometimes reveal heart abnormalities like an enlargement of the left atria. Following this a chest x ray and an echocardiogram is done to confirm the diagnosis of Mitral regurgitation. Electrocardiogram test allows the physician to monitor the direction of flow of blood and this helps in confirming the disease.
reatment options include medications which merely serve to relieve the symptoms and do not help in correcting any deformities of the valve. Medicines are available which help prevent the fluid accumulation in the lungs.
There are other surgical options as well which involves valve repair and replacement. Valve repair is surgery that allows us to modify the original valve to eliminate backward blood flow. The technique is called valvuloplasty. Valve replacement is usually done when valve repair is not possible. The procedure involves replacing the damaged valve by an artificial valve.
Mitral regurgitation may be prevented by eliminating any and all risk factors. Care should be taken so that certain diseases may not develop into rheumatic fever. Also high blood pressure should be kept under check constantly and lifestyle changes should be made properly. It is highly recommended that medical care should be sought in the event of any symptoms suggesting prolapse.
