Treatment Options for Mitral Regurgitation


Medical Treatment

There are no medications that are proven or recommended to treat mitral regurgitation (MR), but there are medications that may be used to treat it's symptoms. For patients diagnosed with Grade 1 (mild) or Grade 2 (moderate) MR, ongoing monitoring of their MR condition, along with treatment of its symptoms, may be sufficient. Drugs that are used to treat symptoms of MR include:

Drugs to promote body fluid loss through urination (diuretics) can help relieve fluid accumulation in your lungs or legs.

Blood pressure medications. Since high blood pressure can worsen MR, your doctor may prescribe medication to help lower your blood pressure. There are many types of blood pressure medication: beta blockers (which reduce heart rate and the heart's output of blood) and vasodilators / ACE inhibitors / calcium channel blockers (which open up narrowed blood vessels).
Antibiotics (drugs that kill bacteria) are used to help prevent or treat endocarditis (infection of the heart's inner lining or the heart valves).
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Surgical Treatment

For symptomatic patients diagnosed with either Grade 3 (moderate to severe) or Grade 4 (severe) MR, surgery is generally recommended. The American College of Cardiology and the American Heart Association also recommend mitral valve surgery (repair or replacement), if the patient's ejection fraction (the amount of blood pumped out of the left ventricle during each heartbeat) drops below 60%, or if the patients left ventricle is larger than 45 millimeters at rest if the patient has no symptoms.

Mitral valve repair or replacement requires hospitalization and involves open-heart surgery, which usually lasts several hours. A patient is placed under general anesthesia for the entire operation. The heart surgeon makes an incision into the patient's chest. Blood is circulated through a heart-lung machine, which adds oxygen to the blood and maintains stable blood flow. The patient's heart is stopped to allow the physician to perform the surgery. The mitral valve is either removed and replaced with a replacement valve or repaired as described below.

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Mitral Valve Repair

Mitral valve repair is usually preferable to mitral valve replacement. Mitral valve repair is accomplished using one or more of the following techniques:

Leaflet resection.  This procedure involves remodeling of the mitral valve by removing some portion of the leaflet tissue and reconnecting them with sutures.

Annuloplasty.  This procedure involves implanting a ring (collar-like structure) around the mitral valve's base, in order to remodel the annulus (opening) and support the repair.
Edge to Edge    This procedure involves fastening the leaflets together where the valve leaks.
Chordal Transposition.  This procedure involves repositioning and re-attaching the fibers (chordae tendineae) that connect to muscles in the left ventricle and that control movement of the mitral valve leaflets.
These techniques are frequently used in combination with each other to minimize the need for re-operation.

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Mitral Valve Replacement

For patients with a hard, calcified annulus (base of the mitral valve) or widespread damage to the mitral valve and its surrounding tissue, replacement of the mitral valve is usually recommended. The damaged mitral valve is replaced with a mechanical (plastic or metal) valve, or a bio-prosthetic valve (either from a human cadaver, or from pig or cow tissue). The damaged mitral valve is removed and the replacement valve is sewn into place.

Mechanical mitral valves have greater durability than tissue or bio-prosthetic valves, but patients who receive them must take medications that thin the blood and reduce the likelihood of blood clotting (anticoagulants) on a permanent basis. However, there are risks associated with these medications, which include increased risk of bleeding, drop in level of blood cells, dizziness, headache, stroke, etc.