The mitral valve connects the left atrium to the left ventricle of the heart and regulates the flow of blood from the lungs to the heart and from there to the rest of the body.
Mitral valve stenosis and mitral valve regurgitation are two different conditions that affect the mitral valve of the heart. Stenosis allows limited blood flow due to insufficient opening of the valve. Regurgitation is due to loose (insufficient) closure of the valve, resulting in backflow of blood into the left atrium.
Both conditions require careful monitoring and appropriate treatment, and if left untreated, can lead to heart failure or other serious complications.
Symptoms of both stenosis and mitral valve regurgitation are common:
- Shortness of breath, especially during exercise or when the patient lies down.
- Fatigue or a feeling of weakness.
- Swollen feet or ankles (due to pressure on the circulatory system).
- Chest pain.
- Arrhythmias, such as atrial fibrillation, due to increased pressure in the left atrium.
The above symptoms should prompt the patient to be checked by a Cardiologist before they cause permanent damage.
Tests for stenosis or regurgitation of the mitral valve
The Cardiologist performs the following tests on a patient with the above symptoms:
- ΙPatient history and clinical examination with a stethoscope to detect any abnormalities.
- Electrocardiogram in the Clinic with a state-of-the-art electrocardiograph, in order to check the electrical activity of the heart and detect any arrhythmias that may arise from the problematic functioning of the mitral valve.
- Doppler echocardiogram (which will record the direction and amount of blood reflux), determining the severity of the insufficiency and the way the left ventricle functions and the extent of possible valve damage.
- Magnetic resonance imaging of the heart in more complex cases or when the echocardiogram does not provide enough information to examine the anatomy and function of the heart with more accuracy.
- Chest x-ray to determine if there is evidence of an increase in the size of the left ventricle or pulmonary congestion due to overload of the heart.
These tests help the Cardiologist evaluate the condition of the mitral valve and determine the appropriate treatment for the patient.
More details about the two mitral valve diseases:
Mitral valve stenosis
Causes of mitral valve stenosis:
- Rheumatic heart disease caused by untreated or poorly treated streptococcal pharyngitis, which leads to inflammation and scarring of the valve. It can also be caused by other infections.
- It is caused by degenerative changes caused by genetic factors or with age.
- A rarer cause is cancer.
Treatment
For mitral valve stenosis, the Cardiologist will administer medications (diuretics to decongest the lungs, beta blockers to prevent arrhythmias, anticoagulant medications in case of atrial fibrillation).
If the patient’s condition does not improve, then he or she should undergo surgery because the progression of the disease is heart failure and a very poor quality of life, the patient is often admitted to the hospital with fluid retention and pulmonary edema, while he or she is at risk of sudden death.
The type of surgery results from various parameters that concern each patient individually: the size of the stenosis, age, general health status, previous heart surgery, etc. Such surgeries are:
Percutaneous dilation of the mitral valve by inserting a balloon to open the valve. It is applied in cases of moderate or severe stenosis.
Surgical replacement or reconstruction of the mitral valve.
Mitral valve regurgitation
Mitral valve regurgitation is mainly caused by:
- Disorder of the muscles or tendons of the mitral valve (e.g., Marfan syndrome or cardiomyopathy).
- Rheumatic heart disease.
- Insufficiency due to atrial fibrillation or left ventricular hypertrophy.
- Degenerative changes that occur with age.
Treatment
Treatment of mitral valve regurgitation includes:
- Diuretic drugs and beta-blockers.
- Percutaneous mitral valve replacement.
- Surgery to replace or reconstruct the mitral valve.
