Treatment for chronicmitral valve regurgitation (MR) includes monitoring your heart function and symptoms, as well as treating symptoms as they develop. If MR becomes severe, the mitral valve will need to be repaired or replaced. Treatment for acute MR is immediate. Medicines and urgent surgery are usually necessary.

As you review your treatment options, consider the following:

• If you have mild-to-moderate chronic MR and no symptoms, your doctor may only monitor your condition.
• If you have moderate-to-severe MR but no symptoms, your doctor may suggest repair or replacement of the mitral valve before symptoms develop, to prevent further heart damage.
• If you have chronic MR, medicines may be used to treat your symptoms and prevent complications. For acute MR, medicines are used to stabilize your condition, but urgent surgery is usually necessary.
• Severe MR generally requires valve repair or replacement to prevent heart failure. Repairing a damaged valve is preferred over replacement.

Initial treatment

Initial treatment for chronic mitral valve regurgitation depends on whether you have symptoms and how severe the regurgitation is. If you don't have symptoms and you only have mild-to-moderate regurgitation, your doctor may only monitor your heart and valve function with an echocardiogram.

The echocardiogram uses painless ultrasound waves to check how well your heart is pumping blood (ejection fraction) and to measure the size of your left ventricle. The smaller the ejection fraction, the harder your heart must work to pump a sufficient volume of blood.

Surgery is recommended when ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹ If you need surgery, your doctor may suggest repairing or replacing your mitral valve to avoid further heart damage. When you begin to have symptoms, the regurgitation is advanced, and you will need surgery to prevent heart failure.

Your doctor may prescribe medicines, such as:

• Vasodilators, such as ACE inhibitors, to help widen blood vessels and help the heart pump more efficiently, if you have symptoms of MR.
• Anticoagulants, such as warfarin (Coumadin), to prevent blood clots if you also have atrial fibrillation.
• Other medicines to control heart rate if you have atrial fibrillation, including beta-blockers, digoxin, or calcium channel blockers.
• Diuretics, for symptoms of heart failure and to reduce the workload on your heart.

Initial treatment for acute MR includes use of the above medicines as necessary to stabilize your condition. If medicines don't help, an intra-aortic balloon pump may be necessary. This device has a balloon attached to the end of a catheter and is threaded up into the aorta, the main artery leaving the heart. The balloon inflates and deflates in sequence with your heartbeat to help circulate blood, decrease the heart's workload, and increase blood flow. Urgent surgery to repair or replace your mitral valve will also be necessary, as well as treatment for the cause of the acute MR.

Ongoing treatment