Mitral Valve Regurgitation: Monitoring, Surgery and Recovery

The basics in one paragraph

The mitral valve sits between the left atrium and left ventricle. When it leaks, the ventricle pumps some blood backward with every beat, so it has to handle extra volume. Over years this stretches both chambers. Mild leaks often never progress. Severe leaks gradually damage the ventricle, sometimes before symptoms appear. For causes and symptoms in detail, see mitral regurgitation; this page focuses on what happens after diagnosis.

Primary vs secondary: why it changes the plan

• Primary (degenerative) regurgitation is a problem with the valve itself, most often mitral valve prolapse or a torn chord. Fixing the valve fixes the problem, and early repair has excellent results.
• Secondary (functional) regurgitation happens because the left ventricle is enlarged or damaged, for example after a heart attack or in dilated cardiomyopathy. The valve is pulled open. Treatment starts with heart failure medicines; a clip may help selected people later.

Reading your echo report

In severe mitral regurgitation, an ejection fraction of 60% is not normal, because a leaky valve makes the heart look stronger than it is.

How often you need an echo

These are typical intervals in the ACC/AHA guideline for primary regurgitation without symptoms:

You should also have an echo if symptoms change. An exercise echo can unmask symptoms in people who say they feel fine but have reduced their activity without noticing.

When surgery is recommended

For severe primary mitral regurgitation, intervention is advised when any of these apply:

• symptoms such as breathlessness or reduced exercise capacity
• ejection fraction 60% or less, or LVESD 40 mm or more
• new atrial fibrillation or high lung pressure
• no symptoms and a normal ventricle, if the valve is very likely to be repairable (over 95% success) at an experienced center, with low surgical risk

Waiting too long risks permanent heart muscle damage. Moderate regurgitation is usually monitored, but it may be fixed during other heart surgery such as bypass grafting.

Repair, replacement or clip

Surgical mitral valve repair

The surgeon reshapes the valve, replaces torn chords with artificial ones and fits a ring to support it. It preserves your own valve, usually avoids lifelong blood thinners, and gives better long-term survival than replacement. It can be done through a standard breastbone incision or minimally invasive or robotic approaches through small chest incisions.

Mitral valve replacement

Used when repair is not possible. Mechanical valves last for life but need lifelong warfarin. Tissue (bioprosthetic) valves do not need long-term warfarin but wear out after about 10 to 20 years.

Transcatheter edge-to-edge repair (TEER)

A clip (such as MitraClip) is passed through a vein in the groin to the heart and clips the two valve leaflets together. It is used for people too high-risk for surgery with primary regurgitation, and for selected people with secondary regurgitation and heart failure who remain symptomatic despite optimal medicines. Most go home in 1 to 2 days.

Recovery after mitral valve surgery

• Hospital stay: about 4 to 7 days after open surgery; shorter after minimally invasive approaches.
• Breastbone healing: avoid lifting more than about 10 lb (4.5 kg) and driving for around 6 weeks after a full sternotomy.
• Cardiac rehabilitation: a supervised exercise program over 6 to 12 weeks speeds recovery.
• Return to work: desk work often at 4 to 8 weeks; physical jobs later.
• Common early issues: tiredness, poor sleep, low mood and a temporary irregular heartbeat (atrial fibrillation) in the first weeks.
• Medicines: blood thinners for some weeks or months after repair or tissue valve; lifelong for mechanical valves.
• Follow-up echo: before discharge or within weeks, then regularly.

Living with mitral valve regurgitation

• Exercise: most people with mild or moderate regurgitation and a normal ventricle can exercise normally. Those with severe regurgitation should discuss heavy weightlifting and competitive sport with a cardiologist.
• Blood pressure: keeping it controlled reduces the leak in some people.
• Dental care: keep teeth and gums healthy. Antibiotics before dental work are recommended for people with a valve repair ring or replacement valve or past endocarditis, not for most people with an unrepaired leaky valve.
• Pregnancy: generally well tolerated with mild to moderate primary regurgitation; severe cases should be assessed and ideally repaired beforehand.

Outlook

People with mild mitral regurgitation have a normal life expectancy. Untreated severe primary regurgitation leads to heart failure and a higher risk of death. When it is repaired before the ventricle weakens, long-term survival is close to that of the general population. Secondary regurgitation's outlook depends mainly on the underlying heart muscle disease.

Frequently asked questions

Is moderate mitral valve regurgitation serious?

Moderate regurgitation usually causes no symptoms and does not need surgery, but it should be monitored with an echo every 1 to 2 years because some leaks progress. Keeping blood pressure controlled and reporting new breathlessness or palpitations promptly are the main steps.

What is the life expectancy with mitral valve regurgitation?

With mild or moderate primary regurgitation, life expectancy is usually normal. With severe regurgitation that is repaired at the right time, it is close to normal. Untreated severe regurgitation or secondary regurgitation from a weak heart carries a poorer outlook.

When should mitral valve regurgitation be repaired?

Repair is recommended for severe regurgitation when it causes symptoms, when the left ventricle starts to weaken or enlarge, or when atrial fibrillation or high lung pressure develops. Some people without symptoms benefit from early repair at an experienced center if the valve is very likely to be repairable.

How long does recovery from mitral valve repair take?

Most people spend about 4 to 7 days in the hospital after open surgery and return to light activities within a few weeks. Full recovery of the breastbone takes about 6 to 8 weeks, and most people feel back to normal by 2 to 3 months, helped by cardiac rehab.

Can I exercise with mitral valve regurgitation?

Yes, in most cases. People with mild or moderate regurgitation and normal heart function can usually exercise without restriction. With severe regurgitation, ask your cardiologist for advice; an exercise test can show what is safe for you.