Mitral Valve Disease — Frequently Asked Questions

The mitral valve helps blood flow in one direction. Mitral stenosis means the valve does not open fully; mitral regurgitation means it does not close properly. Early disease may cause no symptoms. Significant disease can lead to heart failure, rhythm disturbances and an increased risk of stroke in some patients, so appropriate follow-up matters.

Common symptoms include breathlessness, palpitations and tiredness. More advanced disease may cause difficulty breathing when lying flat, swollen legs and reduced exercise tolerance. Some people remain free of symptoms for years. Palpitations in a particular position alone do not establish the diagnosis.

In mitral stenosis, thickening, calcification or fusion of the leaflets restricts the valve opening. Blood has difficulty passing into the left ventricle, increasing pressure in the left atrium and lungs. Breathlessness, palpitations and fatigue may occur. Rheumatic heart disease is an important cause; calcific disease is another, particularly in older people.

The valve does not seal properly, so some blood leaks into the left atrium during contraction. Significant leakage can place extra strain on the heart and cause enlargement. Causes include prolapse or degeneration of the valve, rheumatic disease, infection and changes in the heart muscle after a heart attack or in heart failure.

Causes include rheumatic disease, mitral valve prolapse, degenerative changes or calcification, infection of the valve and congenital abnormalities. Heart attacks and enlargement or weakening of the ventricle can also interfere with valve closure. Their relative frequency varies between populations and between types of valve disease.

Prolapse occurs when one or both leaflets bulge towards the left atrium as the heart contracts. Many people have little or no leakage and need no intervention. Significant regurgitation or certain other findings require closer assessment. Follow-up is based on valve function, symptoms and the individual risk profile.

A heart murmur may prompt investigation. Echocardiography uses ultrasound to assess valve structure, leakage or narrowing, and heart function. A transoesophageal echocardiogram, with a probe in the oesophagus, can provide additional detail when needed, particularly when planning an intervention.

Regurgitation is described as mild, moderate or severe, sometimes using a numerical scale. Severity is assessed from several echocardiographic measurements rather than one number alone. Treatment also depends on symptoms, the cause of leakage, heart size and function, and other findings; a grade by itself does not automatically determine the need for surgery.

Medicines do not reconstruct a damaged valve, but they can relieve congestion, treat heart failure, control heart rate or reduce clot risk when indicated. The choice depends on the type of disease and associated conditions. In some patients, especially with leakage related to heart failure, optimising medical treatment is essential before considering an intervention.

Repair is generally preferred when a durable result is achievable, particularly for degenerative mitral regurgitation. It preserves the native valve and usually avoids lifelong anticoagulation solely because of the repair. Other conditions may still require anticoagulants. Replacement is considered when repair is unsuitable or unlikely to last.

The surgeon reconstructs the leaflets and supporting cords, sometimes adding artificial cords, and commonly implants a supporting ring or band. Surgery usually uses a heart-lung machine and temporary cardiac arrest. Echocardiography checks the result during the operation.

Mechanical valves are very durable but require lifelong vitamin K antagonist anticoagulation, such as warfarin, with regular monitoring. Tissue valves can deteriorate over time and may eventually require another intervention. They do not necessarily require lifelong anticoagulation for the valve itself, but early treatment or other conditions may make it necessary. Age, life expectancy, bleeding risk, pregnancy plans and personal preferences all influence the choice.

It uses a smaller incision, often on the right side of the chest, and usually avoids dividing the breastbone. It may improve some aspects of recovery in suitable patients, but still carries the risks of heart surgery and usually requires a heart-lung machine. Benefits and recovery times vary; not every patient is suitable.

The surgeon controls robotic instruments from a console through small chest incisions and camera ports. The breastbone is usually preserved. A magnified camera view assists the procedure, but the surgeon remains in control. Suitability, risks and recovery are assessed individually; a faster recovery is not guaranteed.

MitraClip is one device used for transcatheter edge-to-edge repair. A catheter passed through a groin vein delivers a clip that joins parts of the valve leaflets to reduce leakage. It may be suitable for selected patients with severe regurgitation, depending on its cause, anatomy, symptoms, medical treatment and surgical risk. A Heart Team compares it with surgical and medical options.

The operation takes several hours. The duration depends on the complexity of the repair or replacement, other procedures performed at the same time and the surgical approach. The treating team can give an estimate for the individual operation.

An initial stay in intensive care is followed by several days on the ward. Around a week is common after uncomplicated surgery, but some stays are shorter or longer. The approach, general health and any complications affect the duration.

Tiredness and some wound discomfort are common initially. Gentle movement and walking usually begin in hospital under supervision, then increase gradually. After a breastbone incision, lifting and movement restrictions follow the surgical team's instructions. Full recovery may take about two to three months or longer; return to work depends on the operation, progress and job demands.

A mechanical valve requires lifelong vitamin K antagonist treatment with regular INR monitoring. After repair or tissue valve replacement, an initial course of antithrombotic treatment may be prescribed; its type and duration vary. Atrial fibrillation or another condition can require longer treatment. Never stop or change anticoagulants without medical advice.

There is no single safe waiting period. Mild or moderate disease may be monitored, with the interval determined by the findings. Severe disease needs specialist assessment even without symptoms because heart function can deteriorate silently. The team balances the benefits of timely intervention against its risks.

Yes. Increased pressure or enlargement of the left atrium can contribute to atrial fibrillation, an irregular heart rhythm. It can increase the risk of blood clots and stroke. The need for anticoagulation and the choice of medicine depend on the valve disease and the patient's stroke and bleeding risks.

Some forms of prolapse and connective tissue disorders can run in families. If there is a family history, a cardiologist can advise whether relatives need assessment or echocardiography. Routine childhood screening is not necessary for every family. Rheumatic valve disease follows an immune reaction to infection rather than simple inheritance of a valve defect.

Pregnancy increases blood volume and the workload of the heart. Significant mitral stenosis and some other valve conditions can pose substantial risks. Anyone with known valve disease who is planning pregnancy should have a pre-pregnancy specialist review, including medication and anticoagulation advice. A cardiology and obstetric team plans care during pregnancy.

Many people with mild disease can exercise, but the appropriate type and intensity depend on symptoms, valve severity, heart function and rhythm. Significant disease may require restrictions until assessment or treatment. After surgery, cardiac rehabilitation and an individual exercise plan help guide a safe return to activity.

Follow-up and echocardiography intervals depend on the type and severity of disease, symptoms and heart function. The team also sets a schedule after surgery. Seek assessment earlier if new breathlessness, palpitations, swelling or reduced exercise tolerance develops. Sudden severe breathlessness, chest pain or stroke symptoms require emergency help.