Mitral valve insufficiency (leaking mitral valve)

Mitral valve insufficiency (mitral insufficiency) is the second most frequently operated heart defect after aortic valve stenosis.

Mitral valve insufficiency (also called mitral insufficiency) is the leakage of the mitral valve, i.e. the sail valve between the left atrium and the left ventricle. The consequence is a constant backflow of blood volume and the resulting overload of the ventricles. As a consequence, cardiac insufficiency can also occur. Typical symptoms of mitral valve insufficiency are rapid fatigue, shortness of breath and cardiac arrhythmia.

The optimal therapy strategy for patients with mitral valve insufficiency, which is developed by our interdisciplinary team, depends on the appearance and stage of the heart defect.

The mitral valve points the way forward: Together with the three other heart valves, it is responsible for the correct flow of blood from the pulmonary circulation into the left main chamber.

The mitral valve consists of two sails. They serve as a gate between the left atrium and the left main chamber. If this gate does not close properly, blood flows from the atrium back into the pulmonary circulation. We're talking mitral valve insufficiency.

The backflow of blood causes the atrium to dilate, and later the main chamber to expand. The heart is confronted with an ever-increasing load.

Symptoms

Patients with mitral valve insufficiency often live free of symptoms. However, if the leakage increases, heart palpitations, breathing difficulties during physical exertion, night-time coughing fits and atrial fibrillation can occur. The main symptoms of mitral valve insufficiency are

General reduction in performance and rapid fatigue
Respiratory distress (exercise dyspnea)
skipped or tachycardia
up to atrial fibrillation

Causes

The causes of mitral valve insufficiency are many and varied: they range from age-related changes in the tissue (e.g. thickening or lengthening), through congenital tissue defects with subsequent tissue prolapse, to calcification, inflammation and changes in the size and function of the left ventricle. Possible causes of mitral valve insufficiency may be

Mitral regurgitation (post-infarction) after heart attack
Mitral insufficiency (ischemic) due to circulatory disorders of the heart muscle
Mitral regurgitation (relative) with dilated left ventricle
Mitral valve prolapse (protrusion of valve parts and inability to close the mitral valve)
Destruction of the mitral valve through inflammation (endocarditis)

When a mitral valve leaks severely, it can affect the lungs, circulation and general performance. These aspects are clarified with various stress tests (six-minute walking test, treadmill or bicycle test). A common complication in severe mitral valve insufficiency is cardiac arrhythmia; therefore, control is based on a resting heart rate curve (ECG) and a long-term ECG over one or two days.

Diagnosis

The diagnosis of mitral valve insufficiency is performed in several stages and involves a wide variety of methods. In addition to the specific anamnesis by the doctor, the physical examination, such as listening to the heart with a stethoscope, including a blood pressure measurement, already provides important information about a possible heart disease. Further diagnostic methods for mitral valve insufficiency are: