Mitral valve insufficiency – causes, symptoms, treatment

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Mitral regurgitation is a defect characterized by the regurgitation of blood into the left atrium during left ventricular contraction. This causes an increase in pressure in the left atrium and, consequently, its dilatation and flickering (disturbed by the rhythm of contractions). The mitral (mitral) valve is located in the left atrioventricular outlet.

What is mitral regurgitation?

Mitral regurgitation is a heart defect characterized by the retrograde flow of blood from the left ventricle to the left atrium. As a result, the pressure in the left atrium rises, which results in its widening and disturbance of the rhythm of contractions (flickering). Since the blood-filled left atrium is unable to receive the blood supplied to it from the lungs through the pulmonary veins, the blood pressure in the pulmonary circulation increases as well. Mitral valve insufficiency is a relatively common heart disease, the main cause of which is damage to the valve leaflets. This defect occurs in both women and men (with the same frequency), and its risk increases with age and blood pressure.

Types of mitral valve regurgitation

Mitral valve regurgitation can be of a nature chronic or acute – then its symptoms are sudden and more intense. While in the case of chronic regurgitation, the heart has time to adapt to the changed conditions (compensatory left atrial widening), in acute ailments, the pressure in the pulmonary circulation increases rapidly, which results in pulmonary edema.

Mitral regurgitation can also be:

1. type I – the mobility of the valve leaflets is normal,
2. type II – the mobility of the valve leaflets is increased,
3. type III – the mobility of the valve leaflets is limited.

Read more: Flap prolapse – disease or different beauty?

The causes of mitral regurgitation

The causes of chronic mitral regurgitation are:

1. heart disease (ischemic disease and cardiomyopathies)
2. systemic diseases: inflammatory (mainly autoimmune);
3. degenerative diseases of the valve apparatus;
4. storage and infiltration ailments;
5. birth defects.

The defect may also develop as a result of the use of certain medications. It can finally be congenital.

Acute mitral regurgitation occurs as a result of changes within the valvular apparatus itself: the mitral valve leaflets, the tendon cords that feed them, and the papillary muscles, and the fibrous ring delimiting the left atrioventricular exit. In addition, the cause of the acute form of the disease may be infective endocarditis or left atrial myxoma.

Congenital form of the mitral valve coexists with such defects of the cheese as:

1. interatrial defect,
2. atrioventricular canal,
3. extra-valvular aortic stenosis,
4. left heart underdevelopment syndrome,
5. aortic stenosis.

Mitral valve regurgitation – the course of ailments

1. Acute regurgitation – occurs rapidly and in a very short time. The left atrium and the left ventricle are overloaded, unable to contain the returning blood. In this form, cardiogenic shock may occur as the volume of blood that should be pumped around the body circumference decreases. In some patients, there is a need for urgent surgical intervention, because large regurgitation leads to a very high load on the circulatory system. Ignoring acute mitral regurgitation usually leads to the patient’s death.

2. Chronic regurgitation – usually takes a long time and tends to worsen gradually. Progressive regurgitation leads to enlargement of the heart cavities. Despite this, the patient may still feel no symptoms during intense exercise. However, the persistence of many years of overload leads to a gradual dysfunction of the left ventricle and incorrect ejection of blood. Chronic regurgitation should be corrected early, before symptoms of left ventricular failure worsen and the changes in the heart are irreversible.

Symptoms of mitral regurgitation

Symptoms of chronic mitral regurgitation are:

1. fatigue,
2. dyspnoea,
3. difficulty swallowing and heart palpitations
4. lack of appetite
5. cough (especially when lying down)
6. pain in the chest,
7. exercise shortness of breath,
8. weight deficiency,
9. enlarged liver
10. swelling in the ankle area.

Symptoms of acute mitral valve insufficiency occur rapidly, most often in the form of dyspnea, cardiogenic shock and a drop in blood pressure.

ATTENTION: Undiagnosed mitral valve insufficiency can lead to dangerous complications such as: right ventricular failure, pulmonary hypertension, and eventually even death.

Mitral valve insufficiency – diagnosis

A cardiologist may suspect mitral regurgitation and its severity by auscultating the patient. It is mainly used to detect a defect The echo of the heart; The change in the shape of the heart, visible in the examination, is of great importance (X-ray) of the chest. The diagnostics also includes ECG (electrocradiography), which helps to determine whether the left ventricle has overloaded and disturbed its rhythm. The EKG picture is usually normal.

How To Treat Mitral Regurgitation?

Treatment of mitral regurgitation involves the use of vasodilators to counteract the development of pulmonary hypertension. In more serious cases, surgical treatment is used to reconstruct the mitral valve or its complete / partial replacement with a biological or mechanical prosthesis.

Implantation of an artificial or biological valve entails numerous complications and often the need for repeated operations. For this reason, it is recommended to have the valve plasty in children, which postpones its replacement for a long time. Plastic surgery may involve suturing the defect in the petals, removing additional tissue, suturing the cleft of the petals, or shortening and splitting the papillary muscles.

In patients where valve surgery is impossible, it is necessary to replace it with a mechanical valve. In children, these are usually double-lobed valves that do not impair the functioning of the left ventricle.

IMPORTANT! Patients who have had a mechanical valve implanted throughout their lives must take anticoagulant preparations to avoid thromboembolic complications.

Text: SzB

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