Understanding your mitral regurgitation treatment options
By ShareMD Connect
Mitral regurgitation can be a serious problem.
If you don’t get treatment, mitral regurgitation can lead to a series of events that lead to heart failure and eventually death. In fact, there’s a 57% chance of dying within one year for those with severe, symptomatic mitral regurgitation.
Even if you’re not experiencing symptoms yet, research shows that damage to your heart may already be happening. But if you are experiencing symptoms like heart palpitations, shortness of breath, and fatigue then it’s even more important that you consider all of your treatment options.
Primary mitral regurgitation treatment options
There are two treatment options commonly prescribed for primary (also known as organic or degenerative) mitral regurgitation. If you have mild or moderate mitral regurgitation with no symptoms, then your cardiologist may just recommend that you monitor your condition with serial echocardiograms. You’ll probably get one every three years if your disease is mild, or every year if it’s moderate.
If your mitral regurgitation is severe, then your physician will probably recommend surgery for either valve repair or replacement. There are two surgical options: open heart surgery or a minimally invasive procedure called TEER, but also known as TVMr, or MitraClip.
Secondary mitral regurgitation treatment options
Secondary mitral regurgitation (also known as functional mitral regurgitation) has a few treatment options.
If your condition is mild then your cardiologist may just recommend that you monitor your condition with repeat echocardiograms. You’ll probably get one every three years if your disease is mild, or every year if it’s moderate.
In addition to monitoring, it’s likely that your doctor will recommend medication to help prevent your heart from changing or your mitral regurgitation from getting worse.
You may be directed onto a plan called Guideline Directed Medical Therapy or GDMT. This therapy will include medications like an ACE/ARB inhibitor, beta blocker, diuretic, and a mineralocorticoid receptor antagonist. The goal of this type of treatment is to reduce the amount of work your heart has to do and relieve symptoms of heart failure.
If your symptoms are still happening and your heart is still showing signs that it’s remodeling itself - even after being on a GDMT plan - then you may be considered for surgery.
Surgical treatment options
In some cases surgery is the best treatment option for mitral regurgitation. The goal of surgery is primarily to repair your valve. You might be a candidate for surgery if you have:
- Severe, symptomatic mitral regurgitation
- Asymptomatic severe mitral regurgitation and your left ventricle is changing or you have low ejection fraction
- Another heart procedure that needs to be done
- Moderate to severe secondary mitral regurgitation with heart failure
Open Heart Surgery
Open heart surgery is the best option for some people. It’s commonly recommended if you need more than one heart procedure. For example, you may be getting your tricuspid valve repaired or having a CABG procedure (coronary artery bypass graft) for coronary artery disease.
You’ll often see open heart surgery shortened to MVR (mitral valve replacement) or MVr (mitral valve repair).
Minimally Invasive Procedures
Minimally invasive procedures to repair your valve could be an option for you. You’ll see this procedure often shortened to TMVr (transcatheter mitral valve repair), TEER (transcatheter edge-to-edge repair) or MitraClip (which is just a brand name for the product used).
This type of procedure is usually recommended for people with primary (degenerative) mitral regurgitation who are considered too high risk to have open heart surgery.
For those with secondary mitral regurgitation (for example, a heart attack caused your mitral regurgitation), a minimally invasive procedure is only recommended if you still have symptoms even after following GDMT (Guideline Directed Medical Therapy).
There are very specific criteria that heart valve specialists use to determine which option would be best for their patients. They take detailed measurements of the left ventricle of the heart, the valve anatomy, and other factors that help them make a decision with you.
When assessing your choices
Mitral regurgitation is a serious disease, but you could have several treatment options available depending on your specific situation. However, your doctor may not immediately discuss all of them with you. This is when you have to become your own advocate and seek a second opinion to make sure you're getting the right treatment for you.