Heart Disease Health Center

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Like initial care for chronic mitral valve regurgitation (MR), ongoing treatment with medicines or surgery varies according to the progression of the disease.

Your doctor may prescribe medicines to help control high blood pressure.

You will need periodic echocardiograms to see if regurgitation is getting worse, and to check the size of your left ventricle and how well it is working. In chronic MR, the left ventricle expands in size as it tries to accommodate the larger volume of blood going into the chamber. The larger the left ventricle, the more advanced the MR.

Your doctor will also monitor your heart's ejection fraction, which is a measure of how well your heart is pumping blood. Ejection fraction is the amount of blood pumped out of the ventricle (stroke volume) divided by the total amount of blood in the left ventricle at rest. 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.

Treatment if the condition gets worse

If your mitral valve regurgitation becomes severe and you have symptoms of heart failure, such as shortness of breath, swelling, and fatigue, surgery to repair or replace your mitral valve will be needed. Surgery is also recommended when your ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹

Some doctors believe it's best to repair or replace the mitral valve before you have severe symptoms because it leads to better long-term health. On the other hand, surgery to correct MR is a major procedure that has its own risks and complications. Even if you have no symptoms, talk to your doctor about the benefits of surgery, along with your heart's condition, your age, and your overall health.

The decision between repairing or replacing the valve depends on the type of damage to the mitral valve. For instance, repair is more successful if there is limited damage to certain areas of the mitral valve flaps (leaflets) or to the chordae tendineae, the tough fibers that control movement of the mitral valve leaflets. But replacement is usually preferred for people who have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue.

Repair may be done by reshaping the valve or removing excess tissue, adding support to the valve ring, or attaching the valve to other cordlike tissues in the heart (chordal transposition).

With replacement, the badly damaged valve is removed, and a mechanical or tissue valve is used to replace the heart valve. Before you have valve replacement surgery, you and your doctor will decide on which type of valve is right for you. To help with this decision, see:

Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?