Heart Check: Symptoms and Solutions for Mitral Valve Disease


With 100,000 beats every day, your heart pumps about 2,000 gallons of blood throughout your body. Your mitral valve plays a critical role in this process, regulating the flow of blood between the upper left heart chamber called the atrium, which receives oxygen-rich blood from the lungs, and the left ventricle below it, which pumps blood to all parts of your body.

If the mitral valve becomes too loose or tight, problems can develop. More than 5.8 million Americans have mitral valve disease, most of whom are over age 65. If you or someone you love is living with mitral valve disease, read on to learn how earlier intervention can save heart muscle and function even before symptoms appear.

Mitral valve disease is responsible for 15% of all valvular heart disease deaths. But recent advances in heart surgery have made it possible to fix or replace the valve without the invasiveness and trauma of the past.

“It’s incredibly important with mitral valve disease that we address the problem early in the disease process while the injury to the heart is still reversible,” says cardiothoracic surgeon Mario Castillo-Sang, MD, an expert in minimally invasive mitral valve surgery.

Understanding the Basics of Mitral Valve Disease

A mitral valve that isn’t working properly can cause these symptoms:

· Shortness of breath

· Fatigue

· New or worsening heart murmur

· Swelling in your legs

· Irregular heartbeat

If you have advanced symptoms, you may have difficulty with daily activities, including taking a shower or getting dressed for the day. Even a short 5- to 10-foot walk can leave you struggling for breath.

However, for many people, there may be no symptoms for years, Dr. Castillo-Sang says.

“We know that a mitral valve leak is akin to a silent injury because some people don’t feel anything,” he says. “By the time they develop symptoms, the damage is already started or done to the heart, and we have problems.”

Over time, mitral valve disease can cause life-threatening complications, such as heart failure, stroke, serious irregular heartbeats called arrhythmias, or high blood pressure in the blood vessels of the lungs.

Mitral valve disease can develop with age, causing leakage back into the upper heart chamber. It can also be a defect from birth or from stiffening and narrowing from scar tissue due to illness like rheumatic fever or a heart attack.

Minimally Invasive Treatment Options

Historically, conventional open-heart surgery through the breast bone was the primary treatment for mitral valve disease. However, in the past decade, Dr. Castillo-Sang says minimally invasive mitral valve surgery has become more commonplace and is on its way to becoming the standard of care.

“Just 10 years ago, very few people performed minimally invasive mitral valve surgery,” he says, noting he’s performed more than 600 of these surgeries. “Today, rather than performing a sternotomy and opening the breastbone, I do 100% of mitral valve operations through a one-and-a-half-inch incision in the right chest.

In some cases, valves are so damaged that they must be replaced. However, repairing an injured mitral valve with a minimally invasive technique works better than a replacement because the heart valve lasts longer, he says. Another option for patients is a transcatheter edge-to-edge repair (clip), which is performed by an interventional cardiologist using a catheter inserted through the groin. Patients with advanced heart failure resulting from a leaking mitral valve may find help through a left ventricular assist device, which requires an open heart procedure.

Ultimately, Dr. Castillo-Sang says, there’s a push to address mitral valve disease as soon as possible to prevent the silent injury to the heart.

“We’re moving toward earlier and earlier referrals for evaluation and potential intervention in severe mitral leakage,” he says. “We know that even without symptoms, the heart is silently sustaining that injury and we want to minimize the damage as much as possible.”

If you have a known mitral valve issue, or if you are experiencing symptoms such as unexplained fatigue, irregular heartbeat, a heart murmur or shortness of breath, talk to your physician about early intervention options. Or talk with our Nurse Navigator at the Florence Wormald Heart & Vascular Institute Structural Heart & Valve Center at (859) 301 8287.