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Mitral Valve Insufficiency

EitherSuspicion: Prof. Dr. Şükrü Akyüz

What is mitral valve insufficiency?

Heart valves are door-like structures that allow blood to pass in one direction. They are opened by the driving force of the blood flow, and kand when the moment's driving force fades, they close. In this way, your blood they prevent it from escaping back. Mitral kapak, kalpteki dört kapaktan biridir. Kalbin sol tarafındaki iki oda arasındadır. Sol kulakçığı sol karıncıktan ayırır. Mitral kapak tam anlamıyla kapanamadığında kan, geldiği odaya, yani sol kulakçığa geri kaçar. Kaçan kan da vücuda gönderilememiş olur. Bu kaçağa, “mitral kapak yetersizliği” veya kısaca “mitral yetersizliği” denir. Yetersizlik instead, yetmezlik or fugitive can also be used; they are synonymous. Mitral kapak yetersizliği, en sık görülen kapak hastalığıdır.

Kaç çeşit mitral kapak yetersizliği vardır?

Mitral valve regurgitation is divided into two categories according to the cause and mechanism of the leak. This classification is important for the choice of treatment:

  • Primary (degenerative) mitral valve insufficiency: Mitral kapağın bizzat kendisinde sorun vardır. Örnekler: Romatizmal mitral kapak, mitral kapak prolapsusu…
  • Secondary (ffunctional) mitral valve regurgitation: Kapak aslında sağlamdır, ama kapağın tutunduğu kalp dokusunda sorun vardır. Kapak, yeterli desteği olmadığından kan kaçırır. Örnekler: Kalp krizi hasarına bağlı olarak kapağın çekilmesi, kalp yetersizliği nedeniyle sol karıncığın büyümesi veya kalpteki ritim bozukluğu nedeniyle sol kulakçığın büyümesi.

What are the causes of mitral valve insufficiency?

  • Mitral valve prolapse (MVP; mcollapse of the itral valve): In a collapsed mitral valve, one or both of the leaflets of the mitral valve bulge towards the left atrium each time the heart contracts. This can prevent the mitral valve from closing tightly and allow blood to escape backwards. Sometimes the bulge is caused by the softness of the leaflets themselves, sometimes by the softness of the strands (chordae) that hold the leaflets together. Spontaneous rupture of these strands can also cause leakage. All of these are of genetic origin. However, they can take many years to progress and cause problems.
  • Congenital Defective lids are present from birth.
  • Age-related arthritis: In some people, the calcification is more than expected and can harden the valve, preventing it from closing properly.
  • Damage caused by infection: Bacterial infections can damage the heart valves either directly (infective endocarditis) or indirectly, as in rheumatic fever. Rheumatic mitral valve insufficiency occurs years after a childhood pharyngitis or tonsil infection and is almost always accompanied by mitral valve stenosis.
  • Heart attack Kin the areas of the alpine muscle that hold the mitral valve heart attackwhat If damage develops due to a heart attack, the support of the valve will be reduced and a leak may develop. If the damage is extensive as a result of a heart attack, this can cause a sudden and severe leak. Leakage can also develop gradually over time.
  • Genetic diseases of the heart muscle: The mitral valve is a structure that ultimately attaches to the heart muscle. Disorders in the heart muscle (e.g, hypertrophic cardiomyopathy) naturally affects the valve.
  • Radiation therapy Rarely, radiation therapy (radiotherapy) for cancers in the chest also affects the valve, destroying its structure. Often, the deterioration of the valve becomes apparent after 15-20 years.
  • Atrial fibrillation: In this type of arrhythmia, the mitral annulus to which the mitral valve is attached enlarges, the valve cusps move further apart and leakage develops. Conversely, when the left atrium enlarges in someone who somehow has mitral regurgitation atrial fibrillation (AF) gelişebilir. Yani, mitral yetersizlik atriyal fibrilasyona; atriyal fibrilasyon da mitral yetersizliğe neden olabilir.
  • Heart failure For any reason heart failure develops and the left ventricle enlarges mitral kapağın tutunduğu mitral halka genişler, kapak uçları birbirinden uzaklaşır ve kaçak gelişir. Bu, en sık karşılaşılan mitral yetersizlik türlerinden biridir. Mitral yetersizlik ilerledikçe kalp yetersizliği de ilerler ve kısır döngü oluşur. Yani, (primer) ileri mitral kapak yetersizliği kalp yetersizliğine neden olabileceği gibi, başka bir nedenle gelişmiş olan kalp yetersizliği de sonradan (sekonder) mitral kapak yetersizliğine neden olabilir. Bazı kalp yetersizliği türlerinde ise kalbin elektriksel ileti yolunda gelişen sol dal bloğu, kalbin sağ ve sol duvarlarının eş zamanlı çalışmasını bozar. Bu, mitral yetersizliğin gelişmesine neden olan farklı bir mekanizmadır. Bu durumda CRT adı verilen kalp pillerinin takılması, kalp duvarlarının eş zamanlı çalışmasını sağlayarak mitral yetersizliği düzeltebilir.

Mitral kapak yetersizliği dereceleri nelerdir?

  • In a sound and properly functioning room, there is a small amount of air passing under the door and we know that this is normal. In the same way, even if there is nothing wrong with the mitral valve, it is normal to have a very small leak. Most people have this very small leak. physiological is called a runaway. Physiological on the run, does not cause any complaints. Physiological instead, artifact and minimal words can also be used. They are not indicative of disease, i.e. they are completely normal not to cause unnecessary anxiety because they are accepted these terms not usually written in the "conclusion" section of the eco report. To summarize: Physiological = Trace = Minimal
  • Non-normal (pathological) leaks are divided into three grades according to the amount of escaping blood: Lightweight, middle and forward. Most doctors consider the intermediate degree to be light-moderate and medium-forward as the "two main types of people". İtheir instead, serious or critical words can also be used. Alternatively, it can be graded numerically, from 1 to 4, with increasing severity. However, numerical grading is not a preferred classification today. To summarize: 1st degree = Mild, 2. degree = Light-moderate, grade 3 = Intermediate-advanced, 4. degree = İleri = Serious = Critical

Mitral kapak yetersizliği belirtileri nelerdir?

Hafif ve orta derecedeki kaçaklar herhangi bir şikayete yol açmazlar ve tedavi gerektirmezler. Ancak, gelen kanın yarısından fazlası geri kaçıyorsa artık sorunun ileri dereceye ulaştığı anlaşılır. İleri mitral kapak yetersizliği geliştiğinde vücuda gönderilen kan miktarı da ciddi derecede az olur. Bu nedenle, kalp daha fazla çalışmak zorunda kalır ve neticede nefes darlığı, çabuk yorulma, çarpıntı veya bacaklarda şişlik gelişir. En ileri safhada kalp yetersizliğine neden olur. Hayat kalitesi bozulur ve günlük olağan aktivitelerin bile yapılması zorlaşır.

How is mitral valve regurgitation diagnosed?

  • ECHO (Echocardiography; ultrasound of the heart): ECHO is the most important test used in the diagnosis of valve diseases. It uses sound waves to obtain images of the heart and can easily detect whether there is a valve leak. Sometimes it is performed through the esophagus to obtain a clearer image. EKO (transesophageal echocardiography; TEE) may be necessary.
  • ECG (Electrocardiography): ECG measures the electrical activity of the heart. It is used to detect heart rhythm problems due to mitral leakage.
  • Chest X-ray: It shows the condition of the heart and lungs. Although it can show that the heart is large, it is not a direct diagnostic test.
  • Emar (MRI; Manyetik rezonans görüntüleme): It is a highly effective diagnostic method used when the diagnosis cannot be made with ECHO.
  • Cardiac catheterization: It is another method used when the diagnosis cannot be made with ECHO. It is similar to cardiac angiography.

Mitral kapak yetersizliği tehlikeli midir?

Mild or moderate mitral valve insufficiency does not require treatment; at certain intervals eco by making follow-up with a doctor is sufficient. In some cases, the degree of regurgitation may progress over time, but in most cases it does not. But, somehow advanced mitral valve regurgitation has developed and is left untreated atrial fibrillation a serious heart rhythm disorder, pulmonary hypertension (high blood pressure in the pulmonary artery), heart failure can develop, which can eventually lead to death.

Does the mitral valve regenerate itself?

Unfortunately, the mitral valve cannot regenerate itself.

Mitral kapak yetersizliği nasıl tedavi edilir?

As mentioned above, only severe mitral valve regurgitation requires treatment. Since the cause and mechanism of leakage are different in each of these patients, the treatments are also different. In treatment; either valve surgery or non-surgical methods are applied. Surgery if possible, the lid is repaired. However, the repair may not be appropriate in all cases or the physician may not have enough experience. In this case, the mitral valve is replaced with an artificial valve. Non-surgical methods are applied to patients who are too risky to undergo surgery. The most common of these is to reduce mitral valve leakage by inserting a latch (MitraClip / Pascal).

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Prof. Dr. Şükrü Akyüz, girişimsel kardiyologdur. Uzmanlık alanı, kalp hastalıklarının ameliyatsız yöntemler ile tedavisidir. Mandal yöntemi de bu tedavilere dahildir.

Which drugs are used in mitral valve insufficiency?

Rather than treating the valve, medications are used to reduce the patient's symptoms and to treat additional conditions that could potentially damage the valve. 

  • Diuretics: Cardiac medicines that draw up water that causes swelling in the lungs or other parts of the body, especially the legs, to be excreted in the urine.
  • Blood thinners: To prevent blood clots if atrial fibrillation (AF) develops due to mitral valve disease blood thinners you may need to take medicines. These medicines significantly reduce the risk of having a stroke.
  • Hypertension medicines: High blood pressure (hypertension) increases the load on the mitral valve, leading to even more blood leakage. Hyperblood pressure control can reduce the amount of leakage.
  • Rhythm medications: Mitral kaçak nedeniyle kalp ritmi bozulabilir ya da tersine rhythm disturbances can cause mitral leakage. So, both can trigger each other. Correcting the rhythm or at least controlling the high heart rate can reduce the amount of leakage.

Controlling the patient's blood pressure and heart rate with medications is very important. For example, in echo performed when blood pressure is high or heart rhythm is disturbed forward a leak that is thought to be of a high degree, after the blood pressure is normalized and the rhythm is checked, the echo actually shows middle degree can be recognized. In this way, unnecessarily premature heart surgery is prevented. 

References

  1. Otto CM, Nishimura RA, Bonow RO, et al. ACC/AHA Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-e197.
  2. Vahanian A, Beyersdorf F, Praz F, et al. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632.
  3. Sorajja, Sato H, Bapat VN, et al. Contemporary anatomic criteria and clinical outcomes with transcatheter mitral repair. Circ Cardiovasc Interv. 2023;16:e012486.
  4. Libby P, Bonow RO, and Mann DL, eds. Braunwald's heart disease: A textbook of cardiovascular medicine, 12th ed. Philadelphia PA: Elsevier; 2022. 

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