Updated October 15, 2014.
The treatment of mitral regurgitation (MR) is surgical. Deciding whether (and when) you may need surgery for MR requires that your doctor determine the correct "stage" of your MR.
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Mitral Valve Surgery
Since MR is a mechanical problem that prevents the mitral valve from closing properly, "definitive" therapy involves surgery to "fix" the mechanical problem.
Two general surgical approaches are used for MR: valve replacement and valve repair.
Mitral Valve Replacement
In mitral valve replacement, the mitral valve is replaced with an artificial (or prosthetic) valve. Prosthetic valves can either consist entirely of man-made materials (mechanical valves), or can be made from an animal's -- generally, a pig's -- heart valve (known as a bioprosthetic valve).
Blood clotting is less of a problem with bioprosthetic valves than with mechanical valves, so people with bioprosthetic valves generally do not have to take chronic Coumadin (blood thinner) therapy, while those with mechanical valves do.
However, mechanical valves generally seem to last longer than bioprosthetic valves, so (in general) mechanical valves are recommended in patients needing mitral valve replacement who are under 65 years of age, as long as they can take Coumadin. For patients 65 or over, or for younger patients who cannot take Coumadin, bioprosthetic valves are generally recommended.
Mitral Valve Repair
In mitral valve repair, the surgeon does not replace the mitral valve, but rather "reshapes" it in order to reduce or eliminate mitral regurgitation. Several techniques have been devised for performing mitral valve repair, but applying any of these techniques is as much an art as a science. So if you are having this procedure, you are much better off going to a surgeon who does mitral valve repairs frequently. (This is the case for mitral valve replacement as well, but it applies doubly to mitral valve repair.)
Death due to surgery is generally lower with mitral valve repair than with replacement, and long-term survival also appears better. So, if repair is an option, it is generally chosen over replacement. Whether repair is feasible depends on the cause and severity of your MR, and the specific anatomy of your mitral valve mechanism. In each case, a careful pre-operative evaluation needs to be done (with the echocardiogram being the most important test) to decide whether repair is an appropriate option.
Other Therapy For Treating Mitral Regurgitation
Vasodilators (drugs that dilate the blood vessels) have been used to treat patients with chronic MR, but these drugs are relatively limited in reducing symptoms or improving outcomes in this condition. They are used mainly in patients whose MR is producing significant symptoms, but who, for one reason or another, are not considered candidates for valve surgery. ACE inhibitors, such as Vasotec (enalapril) or Capoten (captopril), are the vasodilators most commonly used in this condition.
Cardiac Resynchronization Therapy (CRT), a special pacemaker that paces both the right and left ventricle simultaneously, can be useful in some patients with chronic MR who have left ventricular enlargement and who are not candidates for valve surgery.
Endocarditis prophylaxis (taking antibiotics prior to certain medical procedures to prevent endocarditis) is no longer recommended for most patients with MR. If you have MR, you should discuss the need for prophylaxis with your doctor.
Summary
Chronic mitral regurgitation can lead to heart failure and premature death, but with appropriate monitoring and with well-timed mitral valve surgery (if it proves necessary to do surgery), people with chronic MR often do very well over a very long period of time.Sources:
Bonow, RO, Carabello, BA, Chatterjee, K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.
Vahanian, A, Baumgartner, H, Bax, J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28:230.
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