The mitral valve is a small flap in the heart that stops blood flowing the wrong way.Problems with it can affect how blood flows around the body.
The main problems that affect the mitral valve are:
- mitral valve prolapse– the valve becomes too floppy
- mitral regurgitation–the valve leaks and blood flows the wrong way
- mitral stenosis– the valve does not open as wide as it should
These conditions can be serious, but they're often treatable.
In some cases, mitral valve surgery may be needed.
Mitralvalve prolapse
Mitral valve prolapse is where the mitral valve is too floppy and does not close tightly.
Symptoms
Many people with a mitral valve prolapse do not have symptoms and it may only be spotted during a heart scan (echocardiogram) carried out for another reason.
Mitral valve prolapse can sometimes cause:
- dizziness
- breathlessness
- tiredness
- an irregular heartbeat (arrhythmia) or noticeable heartbeats (palpitations)
- mitral regurgitation
Treatment
You probably will not need treatment if you do not have any symptoms.
Your doctor may suggest:
- making lifestyle changes, such as giving up smoking, caffeine and alcohol –these things can make your heart work too hard
- having regular check-ups to monitor your condition
If you have symptoms or your mitral valve is very floppy, your doctor may recommend:
- medicinetorelieve your symptoms, such asbeta blockers for an irregular heartbeat
- mitral valve surgery to repair or replace the mitral valve
Causes
Mitral valve prolapse is usually caused by problems with the tissues that join the mitral valve to the heart muscles.
Some people with the condition are born with it, and it's more common in people with connective tissue disorders, such as Marfan syndrome.
Rarely, it can be caused by damage to the heart muscles themselves – for example, as the result of a heart attack.
Mitralregurgitation
Mitral regurgitation is where some blood flows the wrong way in the heart because the mitral valve does not close properly.
Symptoms
Mitral valve regurgitation does not alwayshave symptoms.
Sometimes it can cause:
- dizziness
- breathlessness
- tiredness
- chest pain
If not treated, itcan lead to:
- atrial fibrillation– an irregular and fast heartbeat
- pulmonary hypertension– high blood pressure in the blood vessels that supply the lungs
- heart failure–where the heart cannot pump enough blood around the body
Treatment
You might not need treatment if you do not have any symptoms. Your doctor may just suggest having regular check-ups to monitor your condition.
Ifyou have symptoms or the problem with your valve is serious, your doctor may recommend:
- medicinestorelieve your symptoms – such as diuretics to reduce breathlessness and medicines for atrial fibrillation
- open heart surgery– to repair or replace the mitral valve
- keyhole surgery – a small clip is attached to the mitral valve to help it close; the clip is guided into the heart through a thin tube inserted into a vein in the groin
Causes
Mitral regurgitation happens if the mitral valve cannot close properly.
This is usually caused by either:
- the mitral valve becoming too floppy(mitral valve prolapse)
- the ring of muscle around the valve becoming too wide
These problems often develop with age– for example, because of"wear and tear"over time or damage caused byuntreated high blood pressure.
Mitral regurgitationcan sometimes becaused by aproblem such as:
- cardiomyopathy–where the walls of the heart become stretched, thickened or stiff
- endocarditis– infection of the inner lining of the heart
- congenital heart disease– birth defects affecting the heart
Mitralstenosis
Mitral valve stenosis is where the mitral valve does not open as wide as it should, restricting the flow of blood through the heart.
Symptoms
Mitral valve stenosis may nothave any symptoms.
Sometimes it can cause:
- dizziness
- breathlessness
- tiredness
- noticeable heartbeats (palpitations)
- chest pain
If not treated, itcan lead to:
- atrial fibrillation– an irregular and fast heartbeat
- pulmonary hypertension– high blood pressure in the blood vessels that supply the lungs
- heart failure– where the heartcannot pump blood around the body properly
Treatment
You might not need treatment if you do not have any symptoms. Your doctor may just suggest having regular check-ups to monitor your condition.
Ifyou have symptoms orthe problem with your valve is serious, your doctor may recommend:
- medicinetorelieve your symptoms – such asmedicines called diuretics to reduce breathlessness and medicines for atrial fibrillation
- mitral valve surgery– to replace the valve or a procedure to stretch it with a small balloon(balloon valvuloplasty)
Causes
One of the main causes of mitral valve stenosis isrheumatic heart disease.
This is where an infection causes the heart to become inflamed. Over time, it can cause the flaps of the mitral valve to becomehard and thick.
Other causes include hard depositsthat formaround the valve with age,ora problem with the heart from birth (congenital heart disease).
Mitralvalve surgery
Mitral valve surgery may be recommended if you have symptoms caused by a problem with your mitral valve orifthe problem is quite serious.
The most commonmitral valve procedures are:
- mitral valve repair
- mitral valve replacement
- balloon valvuloplasty– where the mitral valve is stretched with a small balloon
Mitralvalve repair
Mitral valve repair is an operation to make the flaps of the mitral valve stay closer together. This will help stop blood flowing the wrong way through the valve.
It'smainly used to treat mitral valve prolapse or regurgitation, if the problem is serious and causing symptoms.
The operation is carried out undergeneral anaesthetic, where you're asleep.
Your surgeon will usually get to your heart through a single cut along the middle of your chest, butsmaller cuts between your ribs are sometimesused.
The flaps of the mitral valve are then partially sewn together.
The operation may be done as keyhole surgery, where a small clip is attached to the mitral valve to help it close.
Most people experience a significant improvement in their symptoms after surgery, but speak to your surgeon about the possible complications.
Mitralvalve replacement
Mitral valve replacement is an operation toreplaceyour mitral valve with a mechanical valveor a valvemade from animal tissue (a bioprosthetic valve).
This is usually onlydone if you havemitral stenosis or mitral prolapse or regurgitation and are unable to have a valve repair.
The operation is carried out undergeneral anaesthetic, where you're asleep.Your surgeon will usually replace the valve through a single cut along the middle of your chest.
Most people experience a significant improvement in their symptoms after surgery, but speak to your surgeon about the possible complications. The risk of serious problems is generally higher than with mitral valve repair.
You'll also need to take medicine to prevent blood clots for a long time after this operation. If you have a mechanical valve, you'll need to take this medicine for life.
Balloonvalvuloplasty
Balloon valvuloplasty, alsocalled percutaneous mitral commissurotomy, is a procedure that can be used to widen the mitral valve if you have mitral stenosis.
It's usually done using local anaesthetic, where you remain awake but your skin is numbed.
A small cut is made in your groin or neck and a thin tube is passed along ablood vessel to your heart.
The end of thecatheter has a small balloon attached to it. This is inflated inside the narrowed valve to stretch it wider. The balloon is then deflated and removed along with the catheter.
This procedure is generally less effective than replacing the mitral valve, but recovery tends to be quicker and it may be a better option if your valve is not too narrow or you're at an increased risk of surgery complications (for example, if you're pregnant or frail).
Page last reviewed: 14 October 2020
Next review due: 14 October 2023