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​Mitral Valve Regurgitation

The mitral valve, located between the heart's left upper and lower chambers, has two flaps. These flaps open and close to control the flow of blood through your heart.

Mitral valve regurgitation also referred to as mitral insufficiency, occurs when your mitral valve no longer closes tightly, causing blood to travel in the wrong direction.

The UPMC Heart and Vascular Institute's Center for Mitral Valve Disease specializes in the latest technology to diagnose and treat your mitral regurgitation. Whether your condition requires medication, mitral valve repair, or complete valvular replacement surgery, UPMC vascular surgeons provide you with the best type of treatment.

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What is Mitral Valve Regurgitation?

The mitral valve is a one-way valve located between the heart's left upper chamber (the left atrium) and the heart's lower left chamber (the left ventricle).

When the heart contracts, the mitral valve's two flaps — or leaflets — open to allow blood to move out of the atrium and into the ventricle.

When the mitral valve does not close properly, blood leaks back into the left atrium. This is known as mitral valve regurgitation or mitral insufficiency, which is one of the more common types of heart valve disorders.

Causes of mitral valve regurgitation

Mitral valve prolapse

The most common cause of mitral regurgitation is mitral valve prolapse — a condition when one is born with excess leaflet tissue, known as a “floppy mitral valve.” As one ages, this makes the valve prone to leak.

Mitral valve prolapse occurs when one or both of the valve's two flaps, or leaflets, are too large or stretched. This may prevent the valve from closing tightly.

Over time, one of the leaflets may rupture from its attachment to the heart muscle resulting in worsening leakage of the valve.


Another common cause of mitral regurgitation is endocarditis.

Infection on the valve, or endocarditis, occurs secondary to bacteria entering the blood stream and attaching themselves to the mitral valve. This often happens in people with pre-existing mitral valve prolapse.

The most common cause of bacteria entering the bloodstream is from dental or oral sources. Taking antibiotics before you have dental work performed can help prevent infection.

Other well-known causes of mitral valve regurgitation include:

  • Rheumatic fever — this can also lead to scarring of the leaflets and cause the valve to leak.
  • Heart attack or lack of blood supply to the heart muscle — this can stretch the left ventricle and the mitral valve, causing it to leak. This type of mitral regurgitation is known as “functional” or “ischemic” regurgitation.

Mitral valve regurgitation risks and complications

Factors that increase your risk of mitral regurgitation include:

  • Mitral valve prolapse or mitral stenosis
  • Heart attack
  • Certain medications
  • Age

Without treatment, mitral regurgitation can lead to complications such as:

  • Heart failure
  • Heart enlargement
  • Common heart rhythm problems such as atrial fibrillation
  • Rare heart rhythm problems such as premature ventricular contractions

In very rare situations, mitral regurgitation secondary to severe mitral valve prolapse can result in sudden death.

Why choose UPMC's Center for Mitral Valve Disease for mitral regurgitation care?

At the Center for Mitral Valve Disease, we provide a team-based approach to:

The UPMC Heart and Vascular Institute is also a leader in mitral valve research. This innovative research allows us to provide the latest treatments — such as the MitraClip® — as well as minimally invasive mitral valve techniques. 

Learn More About Mitral Regurgitation

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Mitral Valve Regurgitation Symptoms and Diagnosis

Mitral valve regurgitation symptoms

Mitral regurgitation can exist for years without causing significant symptoms.

When symptoms do occur, they can include:

  • Shortness of breath, often worse with activity
  • Fatigue, or feeling tired
  • Coughing — can often be a dry cough
  • Swelling of  feet or ankles
  • Heart palpitations, which is the sensation of feeling your own heartbeat
  • Chest pain
  • Anxiety

Diagnosing mitral valve regurgitation

In addition to asking you about your medical history, your doctor at the UPMC Heart and Vascular Institute's Center for Mitral Valve Disease will perform a physical exam.

Often, mitral regurgitation causes murmurs, or abnormal sounds of blood flowing through your heart.

Tests your doctor may use to diagnose mitral valve regurgitation include:

  • Echocardiogram, or a heart ultrasound, uses sound waves to create images of the structures of your heart. This is often the first step.
  • Trans-esophageal echocardiogram, or “TEE,” is an outpatient test that uses the same sound technology of a regular echocardiogram but performed within your swallowing tube or esophagus. It allows doctors to get very accurate images of your heart valve, often in 3D. This is one of the best ways to precisely evaluate mitral regurgitation.
  • Electrocardiogram measures the electrical activity of your heart.
  • Chest x-ray enables your doctor to see the size and shape of your heart.
  • Cardiac catheterization is an outpatient test that enables the doctor to see blood flow through the heart and its arteries.
  • Magnetic resonance imaging (MRI) scan uses a magnetic field and radio waves to create images of your mitral valve. 

Learn More About Mitral Regurgitation Symptoms and Testing

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Mitral Valve Regurgitation Treatment

The goals of treatment for mitral regurgitation are to limit or eliminate the leakage of your valve while providing symptom relief and improving the quality and longevity of your life.

If the mitral regurgitation is mild, medications and close follow-up with frequent echocardiograms may be possible. However, because mitral valve regurgitation is a mechanical problem with the flow of blood through your heart, it is often best treated with fixing the mitral valve through surgery such as repair or total replacement.

Doctors at the UPMC Heart and Vascular Institute's Center for Mitral Valve Disease have experience in both minimally invasive and surgical techniques for repairing your mitral valve. Minimally invasive surgery has become more sophisticated, allowing surgeons to perform many heart procedures with smaller incisions.

Whether your condition requires medication, surgical repair, or replacement, the approach your surgeon takes will be based on your needs.

Valve repair surgery for mitral regurgitation

The first line treatment of mitral regurgitation, particularly for mitral valve prolapse, is valve repair surgery. This involves surgically restoring the normal function of the mitral valve by rebuilding one’s existing leaflets using several techniques tailored to the individual anatomy.

At the UPMC Center for Mitral Valve Disease, surgeons perform this operation every day with an overall repair rate over 90 percent.

Benefits of minimally invasive mitral valve surgery

Benefits of making much smaller incisions to gain access to the heart include:

  • Less pain and blood loss
  • Reduced risk of an infection
  • Faster recovery, allowing you to get back to your life more quickly

Often, they can use minimally invasive approaches through a small incision on the front of the chest or, in some cases, through a small incision on the right chest.

Following mitral valve repair surgery, most of our patients are removed from the breathing machine very rapidly — if not in the operating room — and stay in the hospital an average of 3 to 5 days before returning home.

For the first 3 to 4 weeks of recovery, activity is strongly encouraged but heavy lifting and driving is restricted. After 3 to 4 weeks of recovery, a gradual full return to normal healthy activity, including driving, is encouraged.

Minimally invasive robotic-assisted mitral valve surgery

UPMC is a leader in minimally invasive robotic mitral valve repair.

This enables our surgical team to access the mitral valve directly — often through a 2-inch incision — with technical and imaging precision, without any disturbance to the ribs or chest.

The advantages of this approach are less discomfort and an accelerated recovery and return to work or activity.

For people with isolated mitral valve regurgitation due to mitral valve prolapse, robotic minimally invasive repair is the preferred treatment approach.


UPMC is one of the few centers to offer the MitraClip, a minimally invasive approach to repairing valves with mitral regurgitation.

Approved by the U.S. Food and Drug Administration in October 2013, the MitraClip has been shown to improve mitral valve regurgitation symptoms and heart function.

Experts at UPMC's Center for Mitral Valve Disease perform this procedure through a vein in the leg by passing a catheter into the heart and delivering a clip to bring the two leaflets of the mitral valve together.

The MitraClip procedure is reserved for patients that are too high risk for heart valve surgery.

Mitral valve replacement surgery

At the Center for Mitral Valve Disease, mitral repair is always the first line treatment approach, particularly for all patients with degenerative or “floppy” valves such as with mitral valve prolapse.

However, for moderate to severe cases of mitral valve regurgitation, if the valve disease has extensive pathology involving heavy calcium, infection, or stretched severely from heart failure and is not appropriate for repair, then doctors may perform a mitral valve replacement.

Mitral valve replacement is performed with a mechanical valve made of metal leaflets or a biologic valve made of cow or pig tissue.

  • Mechanical valves are long lasting but, due to their metallic leaflets, require patients to take a life-long blood thinner in the form of warfarin (Coumadin®).
  • Tissue valves do not last as long as mechanical valves but they also often do not need life-long blood thinners. Depending on one’s age and condition at the time of implantation, tissue valves may eventually need to be replaced.

A team-based treatment approach for mitral valve regurgitation

At the UPMC Heart and Vascular Institute, we take a team-based approach to treat many of our patients with mitral regurgitation.

Our teams include:

  • Cardiac surgeons
  • Interventional cardiologists
  • Cardiologists
  • Anesthesiologists
  • Nurses

We come together to discuss complex mitral valve cases and tailor a treatment plan to each individual. 

Learn More About Mitral Valve Regurgitation Treatment 

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Mitral Valve Regurgitation Educational Materials

The UPMC Heart and Vascular Institute offers educational information and videos about mitral valve regurgitation and other heart and vascular diseases and treatments.

Many people find these resources helpful in answering their questions about their mitral valve condition and preparing them for their procedure or diagnostic test.

UPMC Heart and Vascular Institute

From our Health Library