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Mitral Regurgitation
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Treatment of Mitral Regurgitation

Reading time: 3 min
  1. Non-pharmacological treatment
  2. Pharmacological treatment
  3. Surgical treatment

Depending on the degree of mitral regurgitation and the patient's symptoms, there are different types of treatment.

As with other heart diseases, patients are advised to lead healthy lifestyles, avoid being overweight and substance abuse, as well as perform aerobic exercise regularly, according to the possibilities of each patient.

This is the basic treatment for heart failure. A number of drugs can be used, depending on the degree of mitral regurgitation and the needs of each patient; e.g., beta blockers and diuretics, among others.

This treatment is recommended for people who have symptoms that noticeably limit their quality of life. In selected cases, early valve repair may be considered in young patients with favourable valve anatomy and few symptoms.

Currently, the surgical treatment for mitral regurgitation is performed via cardiac surgery or percutaneous techniques; that is, minimally invasive surgical techniques. The use of one type of treatment over another depends on the patient, the cause of the disease and the valve anatomy.

Heart surgery

Surgical procedures to access the heart and reach the mitral valve are:

Sternum rupture or sternotomy

Cutting through the sternum (sternotomy).

incisions between the ribs

Minimally invasive surgery by making small incisions between the ribs.

Regardless of the surgical approach, the heart must be stopped to access it and the blood diverted to a heart-lung machine during the operation.

Surgical treatment options for the mitral valve are:

  • Repair of the mitral valve. This is the treatment of choice if the valve properties allow it. It consists of restoring proper closure of the leaflets and remodelling the annulus that holds it (annuloplasty). This repairs the valve without needing to replace it.
  • Replacement of the mitral valve. This is performed when repair is not possible; it consists of replacing the defective heart valve with an artificial one. The following valve types can be inserted:
Artificial heart valve

​​​​​​Mechanical (metallic) Its main advantage is great durability, and so it is usually used in young people However, to prevent clot formation, patients must take anticoagulant medications (acenocoumarol or warfarin) throughout their lives.

Biological heart valve

​​​​​​​Biological (tissue) These are usually made from animal tissue, usually bovine or porcine. They are less likely to cause blood clots, so treatment with anticoagulants is not necessary. However, they are less durable (lasting 12-15 years) and a replacement may be necessary in the future.

Percutaneous procedures

These are performed when patients have degenerative mitral regurgitation, severe symptoms that reasonably limit their quality of life or when surgery for them would be too risky (due to advanced age, surgical limitations or significant associated diseases). Patients with functional mitral regurgitation, whose main problem is the left ventricle, have shown good results with percutaneous repair.

Treatment options are:

  • Percutaneous mitral valve repair using an edge-to-edge clip This consists of implanting one or several small clips to bring the valve leaflets closer together to reduce the degree of mitral regurgitation. The repair is performed by inserting a catheter through the femoral vein (groin) so the heart can be visualised with the help of transoesophageal ultrasound. . To perform transoesophageal ultrasound without discomfort, deep sedation is necessary, and in many cases is performed under anaesthesia with intubation. To be able to perform this type of surgery, the valve anatomy must be appropriate; this is determined by the transesophageal ultrasound performed during the mitral regurgitation study.

  • Percutaneous mitral valve replacement This consists of implanting a biological prosthesis on the patient's own valve. Although a fairly recent procedure, it may be an option for some patients who do not have adequate valve anatomy for percutaneous repair. Currently, there are various devices for fully percutaneous implantation that are in the research phase.
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Substantiated information by:

César Bernadó
Laura Sanchís Ruiz

Published: 23 July 2024
Updated: 23 July 2024

The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.

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