Types of Mitral Valve Disease

At NYU Langone’s Heart Valve Center, our cardiologists, cardiothoracic surgeons, and interventional cardiologists treat people who have conditions that affect the mitral valve. This valve is the gateway between the heart’s left atrium, or upper chamber, which receives blood from the lungs, and the left ventricle, or the lower chamber, which pumps blood through the aorta—the heart’s largest artery—to the body.

The valve has two flaps, called leaflets, that open and close when the heart pumps. These leaflets help regulate the direction of blood flow to the body and prevent the backflow of blood into the left atrium. Sometimes the leaflets do not function properly, making it difficult for the valve to regulate blood flow in the heart.

Robotically assisted mitral valve repair and minimally invasive mitral valve repair are performed by surgeons at our Mitral Valve Repair Program. Transcatheter techniques, including mitral valve repair with MitraClip® and transcatheter mitral valve replacement, are provided by doctors at our Transcatheter Heart Valve Program.

Mitral Valve Regurgitation

When the mitral valve doesn’t close properly, it causes regurgitation, which is when blood leaks backward into the atrium. The heart must then work harder to pump extra blood, causing fatigue, shortness of breath, and, eventually, heart failure, when the heart doesn’t pump enough blood to meet the body’s needs.

The causes of mitral valve regurgitation can be either degenerative or functional. In degenerative mitral regurgitation, irregularities in the valve that develop over time cause gaps or loosen portions of the valve, preventing it from closing properly.

Functional mitral regurgitation occurs when the heart becomes enlarged, typically as a result of a heart attack or heart failure. The expanding heart pulls at the mitral valve annulus, which is the housing that holds the valve leaflets. As a result, the annulus opens wider, pulling the leaflets of the mitral valve apart and preventing them from closing properly.

Mitral Valve Stenosis

In mitral valve stenosis, the leaflets stiffen, preventing the valve from opening completely. This can cause blood to back up into the heart’s left atrium and into the lungs. When that happens, the left atrium enlarges, causing severe shortness of breath.

Because the condition tends to develop slowly over time, symptoms may take decades to become noticeable. They include chest pain, fatigue, and shortness of breath. The condition can lead to an irregular heartbeat, heart failure, stroke, a heart infection called endocarditis, and congestive heart failure that leads to the build up of fluid in the lungs, which is called pulmonary edema.

The most common cause of mitral valve stenosis is rheumatic fever during childhood. This is no longer common in the United States, but it still occurs in other areas of the world. Other causes include congenital mitral stenosis, stenosis from inflammatory diseases such as systemic lupus or rheumatoid arthritis, and age-related mitral annular calcification, which is a buildup of extensive calcium deposits in the leaflets and around the mitral valve annulus.