What happens when your heart, which pumps 110,000 to 120,000 times a day on average, has mitral valve prolapse?
If you’ve been told you have this common valve malfunction, you may also be asking yourself, “What’s the risk that I will need heart surgery and a potential valve replacement?”
A clinical study published in March 2016 in the journal Circulation helps answer this question and more, including who may be more likely to have a severe case.
You may know someone with mitral valve prolapse; it occurs in an estimated two to three percent of the U.S. population.
Heart conditions that put you at higher risk for the condition include an abnormal heart rhythm like atrial fibrillation, heart valve infections, and valve regurgitation.
Before I get into the details of the study, though, I’ll explain more about heart valves and mitral valve prolapse.
How Your Heart Valves Work
First, let’s look at the heart valves. Your heart has four chambers: The upper two are called atria, and the lower two are called ventricles.
The heart chambers are named after the side of the body they’re on — the left atrium and ventricle, and the right atrium and ventricle.
Between these atria and ventricles are two heart valves called atrioventricular (AV) valves. The right AV valve is called the tricuspid valve because it has three leaflets that come together to close.
The left AV valve is called the mitral valve and has only two leaflets.
Blood leaves your right ventricle to go to your lungs, where it’s filled with oxygen, through another valve called the pulmonary valve.
Blood then leaves your left ventricle through the aortic valve to feed your body with the oxygenated blood.
Because blood pressure in the lungs is low, the right side of your heart is the low-pressure side.
Blood pressure on the left side is higher, which means that the valves on this side of your heart close against more force.
The blood pressure on the left side is what’s measured as blood pressure.
As mentioned above, your heart pumps more than 100,000 times a day.
If it’s not pumping normally, and one of your valves becomes narrowed or leaky, a physician will often hear a heart murmur.
The timing, intensity, and location of the murmur all help show which valve is involved, and whether it’s leaky or narrowed.
How Your Mitral Valve Can Prolapse
The mitral valve is the one that closes when your strong left ventricle begins to contract to push blood throughout the body.
A common condition called a myxomatous valve can develop when the the valve doesn’t close properly because the leaflets have extra tissue.
When a myxomatous mitral valve closes and the ventricle contracts, the force on the valve causes it to prolapse (balloon out) into your left atrium.
An analogy is a parachute that opens and balloons, or prolapses, up to form a sphere. With the mitral valve, the more tissue there is, the more it will prolapse into your left atrium.
Sometimes this results in blood leaking into the left atrium, a condition called mitral regurgitation.
Symptoms of Mitral Valve Prolapse Progression
Although the valve prolapse typically doesn’t cause symptoms, they can develop when the valve begins to leak or regurgitate.
The heart can tolerate leaky valves more than it can narrowed orstenotic (too tight) valves. So the symptoms of regurgitation often develop gradually.
Symptoms of mitral valve prolapse with regurgitation can include:
- Feelings of anxiety
- Palpitations
- Shortness of breath
- Dizziness
- Chest pain
Complications After Mitral Valve Prolapse
A few health complications can develop when your mitral valve prolapses.
- Abnormal heart rhythms.Conditions like atrial fibrillation most often develop in the upper heart chambers and aren’t life threatening. You may need an ultrasound test called an echocardiogram to make sure the leaking hasn’t become severe. If it has, you can develop abnormal rhythms in both the upper and lower heart chambers — and abnormal heart rhythms in the lower chambers can be life threatening.
- Abnormal, leaking valves can cause turbulent blood flow, which injures the valve leaflet surface. When this occurs, risk of infection on the heart valve, called endocarditis, can increase. To prevent this complication, physicians often recommend antibiotics before dental and medical procedures. Throughout my career, clinical recommendations have changed based on whether people who have leaking mitral valve prolapse need antibiotics. Right now, the trend is not to use antibiotics unless your physician feels you’re at added risk for endocarditis.
- Valve Regurgitation.The most common complication of mitral valve prolapse is mitral valve regurgitation (the backward flow of blood). Men — particularly those over age 50 — and people with high blood pressure are at highest risk of worsening regurgitation. If it’s severe or symptomatic, open heart surgery is often required.
In my opinion, if your valve regurgitation is severe, consider surgery earlier on and choose a center that performs many of these operations every year.
Also choose a surgeon who has extensive experience repairing and replacing valves.
A repaired valve is a better option than any of the newest artificial valve technologies — if your heart valve condition will allow it.
What’s the Risk of Severe Heart Valve Problems?
Back to the study in Circulation: The researchers evaluated 261 people with mitral valve prolapse who participated in the Framingham Heart Study and who also had frequent ultrasound studies done of their heart during a follow-up period of up to 16 years.
Over that time, mitral valve prolapse progressed to regurgitation in 34 percent of the participants. In 17 percent, the regurgitation became moderate to severe. Eight people (11 percent) underwent surgical mitral valve repair. Regarding abnormal heart rhythms, 12 percent developed atrial fibrillation.
The researchers then looked for risk factors that predicted progression of heart valve dysfunction and regurgitation. Here’s what they found:
- Family history matters. Having a parent who had mitral valve prolapse made it twice as likely that children would have mitral valve prolapse.
- Major risk factors for disease progression include obesity and both high systolic and diastolic blood pressure.
- People who developed progressive prolapse and thickening of the valve had the highest rates of progression to more severe regurgitation.
This study taught us several important things about mitral valve prolapse: It runs in families, and family members of people that have mitral valve prolapse — particularly those who need heart surgery — should be screened by their physician.
Progressive valve dysfunction in people with mitral valve prolapse is more common than we previously recognized. Because of this, routine ultrasound screening of the valve should be considered.
If you have mitral valve prolapse and want to lower your chances of mitral valve regurgitation, take these preventive measures now:
- Keep your weight in a healthy range
- Get enough exercise
- Eat a healthy diet
- Lower your blood pressure
In addition, see your physician to begin treatment early to lower the pressure on your heart valve.
