The mitral valve is a heart valve that lies between the left atrium and left ventricle. Mitral regurgitation is sometimes called mitral insufficiency or mitral incompetence. In mitral regurgitation the valve does not close properly. This causes blood to leak back (regurgitate) into the left atrium when the left ventricle squeezes (contracts). Basically, the more open the valve remains, the more blood regurgitates and the more severe the problem.
Dr Sarah Jarvis, 27th November 2021
NICE guidance on heart valve disease
This leaflet has been archived and has not been reviewed since 2017. It does not include the latest guidance on investigations and treatments for mitral regurgitation from the National Institute for Health and Care Excellence (NICE), which were released in November 2021.
You can find out more about NICE's recommendations from the link labelled NICE NG208 Heart valve disease presenting in adults: investigation and management, in the further reading section at the end of this leaflet.
Mitral valve prolapse
This is also called floppy mitral valve. In this condition the valve is slightly deformed and bulges back into the left atrium when the ventricle contracts. This can let a small amount of blood leak back into the left atrium. As many as 1 in 20 people have some degree of mitral valve prolapse. It most commonly occurs in young women. It usually causes no symptoms, as the amount of blood that leaks back is often slight. The cause of most cases of floppy valve is unknown. It sometimes occurs with connective tissue disorders such as Marfan's syndrome.
Mild mitral regurgitation may not cause any symptoms. However the symptoms associated with more severe mitral regurgitation include:
- Shortness of breath, especially with activity or when you lie down
- Heart palpitations
- Swollen ankles (oedema)
Mild cases may not require any regular medication. Although medicines cannot correct mitral regurgitation, some medicines may be prescribed to help ease symptoms, or to help prevent complications - for example, angiotensin-converting enzyme (ACE) inhibitors, 'water tablets' (diuretics) and anticoagulation medication. If you develop atrial fibrillation, several medicines can be used to slow the heart rate down.
Surgical treatment is sometimes needed. Recent guidelines favour surgery at an earlier stage than used to be the case.
- Valve repair may be an option in some cases.
- Valve replacement is needed in some cases. This may be with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with your body, such as titanium. Tissue valves are made from treated animal tissue, such as valves from a pig.
Recent guidelines favour replacement rather than repair in many cases. If you need surgery, a surgeon will advise on which is the best option for your situation.
What is the outlook for people with mitral regurgitation?
In some cases, the disorder is mild and causes no symptoms. If you develop symptoms they tend to become gradually worse over the years. However, the speed of decline can vary. In many cases, it can take years for symptoms to become serious. Medication can ease symptoms but cannot reverse a damaged valve.
Surgical treatment has greatly improved the outlook in most people with more severe regurgitation. Surgery has a very good success rate.
Further reading and references
Nishimura RA, Otto CM, Bonow RO, et al; 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2017 CIR.0000000000000503. Originally published March 15, 2017.
2015 ESC Guidelines for the management of infective endocarditis; European Society of Cardiology (Aug 2015)
Prophylaxis against infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures; NICE Clinical Guideline (March 2008 - last updated July 2016)
Vahanian A et al; Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology, 2017
Ozkan M; What is new in ACC/AHA 2017 focused update of valvular heart disease guidelines. Anatol J Cardiol. 2017 Jun17(6):421-422. doi: 10.14744/AnatolJCardiol.2017.7925.
Heart valve disease presenting in adults: investigation and management; NICE guideline (November 2021)