Mitral valve prolapse is a common heart valve condition, affecting approximately 2 percent of the U.S. population, according to the American Heart Association. For many people, the condition is not considered dangerous, but does need to be managed and monitored by your physician. When the prolapse and associated regurgitation through the valve is severe, an intervention may be necessary to correct the problem.
What Is the Mitral Valve?
The mitral valve is an important valve in the heart that separates the left ventricle (the main pumping chamber of the heart) from the lungs. The valve is comprised of two flaps, or leaflets, that open and close with each heartbeat. Regurgitation, or leakage through this valve, is relatively common and is a result of the two leaflets not closing properly to create a perfect seal.
The most common cause of regurgitation—which can range from mild to severe—is mitral valve prolapse. With this condition, one or both of the valve leaflets bulge (prolapse) upward into the left atrium. This finding is often a result of the valve stretching, or a tear/rupture in the support structures (chordae tendineae) that attaches the valve to the underlying left ventricle.
Symptoms of Mitral Valve Prolapse
Symptoms of mitral valve prolapse can include:
- Shortness of breath with activity
- Difficulty lying flat
- Irregular heart rhythms
- Swelling in the legs
However, many patients show no symptoms and only learn of their condition when their doctor detects a heart murmur during a routine physical exam. They are often referred for an echocardiogram or MRI—the best ways to determine the severity of leakage. As the degree of the regurgitation worsens, symptoms often follow.
Mitral Valve Prolapse Treatment
Initially, cardiologists often treat mitral valve prolapse with diuretics, blood pressure medications, and blood thinners used to treat irregular heart rhythms. Patients with less severe regurgitation should be monitored regularly by their cardiologist.
If the regurgitation is severe (even if there are no symptoms), cardiologists may recommend a surgical procedure. If not treated for an extended period of time, the regurgitation can eventually lead to heart failure and death.
Surgical Repair of the Mitral Valve
In otherwise healthy individuals, mitral valve surgery is an option that has an excellent safety record and excellent results. A March 2020 study, in fact, showed that surgical repair of the mitral valve for mitral valve prolapse restores life expectancy to that of the general population.
For most patients, their own mitral valve can be repaired to correct the regurgitation. This procedure can be done using minimally invasive techniques, particularly if there are no other heart problems that need to be addressed at the same time.
Surgeons make a small 2-3-inch incision near the right armpit, often using a camera to help see the valve very clearly. The prolapsed and regurgitant valve is the corrected by removing that area of the valve, restoring torn support structures, and/or tightening the valve with a supportive ring.
A minority of individuals with mitral valve prolapse cannot have their own valve repaired and must have it replaced. This can be with a bioprosthetic valve (cow or pig) or a mechanical valve.
MitraClip Procedure for High-Risk Patients
In individuals at high risk for surgery, a less invasive, catheter-based option called MitraClip is offered at Penn Medicine Lancaster General Hospital. A team from Cardiac Surgery and The Heart Group work together to attach a small device to the mitral valve that allows it to close more completely, helping restore normal blood flow to the heart.
Staying Healthy with Mitral Valve Prolapse
Most people with mitral valve prolapse live normal lives. To help prevent complications:
- Don’t smoke
- Eat a heart-healthy diet and exercise regularly (after consulting your family doctor)
- Take all prescribed medications as directed
- Visit your doctor for all scheduled physical exams and notify your doctor if you notice common cold and flu symptoms, such as a sore throat, achiness and fever. These symptoms could signal endocarditis (a bacterial infection that affects the lining of the heart valves).
- Maintain good oral hygiene which has been found to reduce the risk of endocarditis