Internal Medicine

Mitral valve regurgitation

definition

In the Mitral valve regurgitation it is a heart valve defect of Mitral valve (Bicuspid valve), which the left atrium of the heart with the left ventricle connects.

As a result of an insufficiency, the valve no longer closes completely and blood can flow more or less between the atrium and ventricle in all phases of the heart's action.

If more than 15% of the blood, which is normally pumped into the circulatory system from the left ventricle, returns to the atrium, it is called a relevant mitral regurgitation.

Read more about the topic here: Valvular heart disease

causes

It must generally be between a primary and a secondary Mitral valve regurgitation can be distinguished.

A primary insufficiency occurs when the valve itself is responsible for the malfunction and thus causing the insufficiency. Congenital malformations, calcifications of the valve, infections and disorders of the valve holding apparatus are possible causes of primary insufficiency.

A secondary insufficiency arises due to changes and diseases of the heart. Secondary insufficiencies are caused by changes in shape or by a loss of function of the heart muscle.

Since the change in this case is not primarily caused by the valve itself, one speaks of a secondary cause in these cases. Examples of secondary causes leading to a Mitral valve regurgitation are one Cardiac hypertrophy (Enlargement of the heart muscle), Inflammation of the heart muscle (Myocarditis), or one Reduced blood flow to the heart because of a coronary heart disease.

In addition, a acute mitral regurgitation occur. This is for example from acute bacterial infections or injury to the heart and represents one cardiac emergency represent.

Symptoms

A chronic mitral regurgitation often develops over a long period of time, which is why symptoms appear relatively late.

Typical symptoms of chronic mitral regurgitation are one general exhaustion, especially under stress Difficulty breathing and water retention.

Also a to cough, which typically occurs at night, is typical of valve regurgitation.
That's how it is general efficiency of affected persons with a relevant mitral regurgitation.

When listening to the heart there is a typical heart murmur perceptible, which is groundbreaking for the diagnosis of mitral valve insufficiency.

Insufficiency of the right heart develops especially if the insufficiency persists for a long time. This insufficiency can be with a Congestion of blood in the liver, kidneys and neck veins accompanied.

It can also too Arrhythmias of the heart's action come. In some cases, these are caused by noticeable heartbeats (Palpations) noticeable.
Cardiac arrhythmias can have serious and life-threatening consequences such as the emergence of a Blood clot entail.

diagnosis

At the beginning of the diagnosis there is a detailed anamnesis (doctor-patient conversation), as well as the physical examination of the person concerned.
The exact description of the symptoms can often provide the first clues for diagnosing the disease. The heart is then typically monitored with a stethoscope (auscultation).

Mitral valve regurgitation shows a heart murmur that is often sufficient for the trained examiner to make the suspected diagnosis. A sonographic examination (ultrasound) of the heart can either confirm or disprove the suspected diagnosis of valve insufficiency.
The ultrasound can be carried out via a so-called "transesophageal echo" via the esophagus as well as from the front of the chest. The ultrasound examination of the esophagus is also known colloquially as swallowing echo.

Furthermore, the catheter examination of the vessels of the heart is often necessary for further therapy planning. In individual cases, imaging examinations with an MRI or CT can be useful.

Auscultation

The Auscultation of the heart describes the listening to heart sounds and possibly pathologically occurring ones Heart murmurs with the help of a stethoscope.
A trained doctor can often make the suspected diagnosis of relevant mitral regurgitation based on auscultation.

The insufficiency of the valve causes a pathological flow noise, which in the so-called Systole (when the heart muscle is contracted) and is typically heard loudest in the 4th or 5th space between the ribs on the left side of the body.
If the sound can be heard in the armpit while listening, it can be assumed that the problem is mitral regurgitation.

Conservative therapy

The individual possibility of conservative therapy depends on several factors. On the one hand, it is relevant whether it is a primary or secondary mitral regurgitation acts. Also is the Degree of insufficiency determining the possibility of conservative therapy.

Primary mitral regurgitation gives hardly any leeway for drug treatment and is therefore usually operational corrected.

A secondary mitral valve regurgitation arises from other heart diseases. The therapy in this case depends on the severity of the insufficiency and the underlying disease.

So the basic disease should always be adjusted as best as possible. The gift of so-called ACE inhibitors, beta blockers, and spironolactones can represent suitable therapeutic measures in the context of cardiac insufficiency, which also exists or has arisen in the context of mitral valve insufficiency.

While conservative therapeutic measures in a mild and moderate mitral regurgitation may be considered will be a severe mitral regurgitation usually treated surgically.

surgery

Not for everyone Mitral valve regurgitation surgical therapy can be recommended. Depending on the severity and the prevailing comorbidities, there may be individual surgical indications and contraindications.

In general, the indications for surgical therapy differ depending on whether there is primary or secondary mitral valve regurgitation. As a rule, severe mitral valve insufficiency is an indication for surgical intervention. Depending on Pumping function of the heart Moderate insufficiency can also be an indication for surgery.

If symptoms occur that are directly or indirectly caused by mitral regurgitation, surgery is usually considered.
Even if conservative therapy options have been exhausted, surgical treatment can represent the next therapeutic step.

In any case, the function of the heart is an important characteristic for the question of whether there is an indication for an operation. A relevant heart failure can for example be a Contraindication pose for surgery.

Operational risks

As with any surgical procedure, there is also one with operations Mitral valve regurgitation Risks.
Since the operations differ significantly depending on the underlying cause of the insufficiency, there are different risks with each operation.

In general, operations for mitral valve regurgitation of primary cause tend to be less risky than surgery for mitral valve regurgitation of secondary cause. This is mainly due to the fact that the Cardiac output is often impaired in the case of secondary insufficiencies.

Surgery risks can Blood clots, cardiac arrhythmias, and wound healing disorders be.

Also a malfunctioning one Valve reconstruction can occur in individual cases.
Any risks posed by the anesthesia occur are also part of the procedure and should therefore be taken seriously.

Duration of the operation

The Operation time depends largely on the procedure carried out.
While minimally invasive surgery can be completed within an hour Open heart operationsn usually a little longer.

Here again, a distinction must be made whether the connection to the Life-support-machine occurs or whether the operation at the beating heart can be carried out.

The open heart surgery usually takes about 2-3 hours. Complications during the operation or individual planning can add a few hours to the operation.

Figure mitral valve

Tricuspid valve -
Tricuspid valva
Mitral valve -
Valva mitralis
Aortic valve -
Valva aortae
Pulmonary valve -
Valva trunci pulmonalis
Right atrial -
Atrium dextrum
Right ventricle -
Ventriculus dexter
Left atrium -
Atrium sinistrum
Left ventricle -
Ventriculus sinister
Papillary muscle -
Papillary muscle
Superior vena cava -
Superior vena cava
Aortic arch - Arcus aortae
Pulmonary artery trunk -
Pulmonary trunk
1 + 2 sail flaps
= Atrial clamp valves
= Atrioventricular valves
= AV valves
3 + 4 pocket flaps

You can find an overview of all Dr-Gumpert images at: medical illustrations

Exercise for mitral regurgitation

People who participate in a Mitral valve regurgitation often the question arises whether exercise recommended or whether it can even cause damage. The answer to this question, as in most cases, is complex.

Before any physical activity with a friend chronic heart failure should be doctor Be visited to find out whether further therapeutic measures are necessary before starting physical activity.
The individual severity of the illness must be taken into account in order to be able to make a recommendation for carrying out sporting activity.

Should Circulatory problems occur during sport is recommended in any case a visit to a doctor, to avoid complications of the disease. As a general rule, no physical activity can be recommended in the case of symptomatic mitral valve regurgitation, regardless of the severity.

People who participate in a minor mitral regurgitation suffer, can be physically active without restriction. The heart can usually compensate for a slight insufficiency, which is why even greater loads are not a problem.

People with moderate mitral regurgitation can also be active in sports as long as no symptoms occur. Also has to Cardiac function are in the normal range. However, regular cardiac check-ups should be performed to avoid serious complications.
In the case of impaired heart function, individual advice from the treating cardiologist can clarify which sport is individually suitable.

A severe mitral regurgitation is initially a contraindication for all stressful endurance sports. If there are no symptoms, light sporting activities may be possible.

There are some studies that deal with the issue of whether exercise in mitral valve regurgitation can improve the prognosis of the disease. So far, it has been confirmed that endurance training can have a protective effect on cardiac insufficiency that has not yet existed and thus improve the prognosis of the disease.
If you already have severe heart failure, however, exercise has an effect negative on the prognosis the disease.

For mitral valve insufficiency, which is associated with low-grade heart failure, a individual medical assessment to what extent physical activity can be recommended. In any case, ask your doctor beforehand for advice on whether and in what form you can exercise.