The mitral regurgitation mitral is an alteration of the mitral valve characterized by that it is incompetent, that is not closed properly. It occurs because there is an alteration in some element of the system that makes up the valve (papillary muscles, chordae tendineae, leaflets), which prevents the juxtaposition of the free edges of the leaflets.
During systole, the mitral valve closes so that the blood driven by the contraction of the heart is directed towards the aorta. If the mitral valve does not close completely, part of the blood from the ventricle will escape into the atrium, which is why it is subjected to an overload of pressures and volumes for which it is not prepared, which ends up altering the balance that regulates the functioning of the heart.
Mitral valve regurgitation appears more in men and is usually a chronic disorder, although there is some acute case of rupture of one of the papillary muscles that are responsible for moving the leaflets.
Causes of mitral regurgitation
There are multiple causes of this pathology:
- Almost 1/3 of the cases are due to rheumatic fever, which produces stiffness, deformity and retraction of the leaflets and fissure of the commissures, in addition to contraction and stiffness of the chordae tendineae that join the leaflets with the papillary muscles, all of this makes complete mitral closure impossible.
- When a myocardial infarction affects the base of a papillary muscle upon healing, it produces fibrosis in the area that alters the functioning of the muscle. In addition, the infarction can lead to the rupture of one of these muscles, which leads to acute mitral valve regurgitation.
- Angina pectoris episodes can also cause transient mitral regurgitation.
- Any process that leads to enlargement of the left ventricle produces this condition due to dilation of the valve annulus and lateral displacement of the papillary muscles, which will prevent the coaptation of the leaflets.
- Another cause is hypertrophic cardiomyopathy, in which one of the leaflets is displaced, thus increasing the mitral area that cannot be completely closed.
- Calcification of the mitral annulus, of unknown and probably degenerative cause, which occurs more frequently in elderly women, can also be the cause of mitral valve regurgitation.
- Mitral valve prolapse also causes regurgitation.
- The endocarditis infectious affecting the cusps or chordae is another possible cause.
- There is also a congenital mitral valve regurgitation.
Symptoms of mitral regurgitation
The most striking annoyances of this alteration are dyspnea (respiratory distress) that at first only appears with great efforts and that progressively becomes more and more frequent until daily activities are prevented, orthopnea (difficulty breathing except in an upright position) and continuous feeling of tiredness due to low blood flow from the heart.
Unlike mitral stenosis, in mitral regurgitation the appearance of embolisms or hemoptysis (bleeding from the mouth) is very rare, almost exceptional. In highly advanced cases in which hypertension has developed in the pulmonary veins, right heart failure will occur with all the symptoms that characterize it, such as painful liver congestion, edema in the lower extremities and declining areas, dilation of the veins. neck, ascites and even tricuspid valve regurgitation.
All of these symptoms appear in the chronic form of the disease. In the acute forms, left ventricular failure is established with acute pulmonary edema and cardiovascular collapse (hypotension, increased heart rate, anuria…).
How is it diagnosed?
There are several tests that should be performed in every patient in whom we suspect this pathology:
Auscultation: The most important auscultatory finding is the presence of a systolic murmur, more intense at the tip, radiating to the armpit and increasing with exercise. This murmur is more audible the more severe the valve involvement. Other more subtle findings will be the presence of a third low tone that indicates severe mitral valve regurgitation and absence or masking of the first tone due to the systolic murmur.
Electrocardiogram: Evidence of left atrial enlargement appears. If it is very dilated, as it happened in mitral stenosis, arrhythmias can develop , mainly atrial fibrillation that we will detect in the electrocardiogram. In cases in which dilation and hypertrophy of the left ventricle have developed, these alterations will also be observed on the electrocardiogram.
Chest X-ray: The left atrium and ventricle are the cavities best seen on X-ray. In chronic cases, the dilation of these structures is correctly visualized. If there is calcification of the mitral annulus, it can be seen; as well as congestion and pulmonary edema.
Echocardiogram : It is the most useful non-invasive technique to detect mitral valve regurgitation and determine its degree. Findings that can help us determine the cause of the alteration are frequently identified, including the presence of vegetations that are associated with infective endocarditis.
Catheterization and cardiac angiography: Sometimes it is the only test that tells us what degree of insufficiency exists, it also allows us to quantify the function of the left ventricle in cases where it is altered by means of contrast ventriculography. It is an invasive test that poses a certain risk, so its use is limited to a selected number of patients.
Treatment of mitral regurgitation
There are two treatment alternatives that basically depend on the degree of insufficiency that exists, medical and surgical treatment.
The first step consists of restricting the activities that cause dyspnea and fatigue, as well as the use of diuretics and digitalis and ACE inhibitors to control heart failure when it appears. If there is atrial fibrillation, treatment consists of antiarrhythmics to reverse the disorder or, if necessary, electric shock. Sometimes if the atrium is very dilated, reversal will be impossible and treatment is aimed at keeping the frequency within acceptable limits with digitalis or beta blockers.
In advanced stages of heart failure, it will be necessary to anticoagulate the patient to reduce the risk of venous thrombosis and pulmonary embolism.
Patients with asymptomatic mitral valve regurgitation or who only have limitations to very intense exercise are not considered in favor of surgical treatment. It should be offered to those whose limitations do not allow them to work normally or perform normal household tasks despite optimal medical treatment. It is only indicated in patients with mild symptoms if severe left ventricular dysfunction is proven or by ultrasound a rapid progression of ventricular dilation is demonstrated.
In every patient who is going to undergo surgery, a catheterization should be performed previously to verify the importance of the insufficiency and make sure that there is no other valvular disease or alteration of the coronary arteries, since if they exist they must be repaired in the same intervention.
There are two possible interventions. On the one hand, if the valve apparatus is severely damaged with retractions and calcifications of the leaflets, the treatment of choice is valve replacement by mechanical or biological prosthesis, depending on the patient’s conditions. If, on the other hand, there is a great dilation of the valve ring, flaccid leaflets, rupture of the chords or infective endocarditis, the most indicated treatment will be the reconstruction of the mitral valve (mitral valvuloplasty). Valvuloplasty should be performed whenever possible since the risk of the intervention is lower and the long-term complications as well.
How can I avoid it?
The best way to prevent it is to avoid the appearance of rheumatic fever for which it is necessary that all pharyngeal infections caused by streptococcus receive adequate antibiotic treatment.
In addition, an exhaustive control of cardiovascular risk factors ( arterial hypertension , diabetes , hypercholesterolemia) must be carried out to avoid, as far as possible, the appearance of angina pectoris or myocardial infarction that can cause mitral valve regurgitation.
Finally, remember that in the presence of any symptoms of this pathology, you should see a doctor since an early diagnosis favors good control.
The presence of dyspnea, orthopnea and chronic fatigue should make us go to the doctor as soon as possible, since they are symptoms that can translate a large number of pathologies, many of them very serious.
The early diagnosis of this condition can be very beneficial since it allows us to establish a treatment that improves the symptoms and also allows us to choose the optimal moment in which to intervene.
The presence of a murmur in a routine examination also deserves evaluation by the doctor, and thus determine if it is a trivial murmur of no importance or if it reflects an alteration of the valves.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.