Mitral valve disease

Your heart has four valves. They work like one-way doors, opening to let blood through and closing to stop it from flowing backwards. The mitral valve sits on the left side of the heart, between the upper chamber (the left atrium) and the lower chamber (the left ventricle). The left ventricle is the heart's main pump, pushing oxygen-rich blood out to the rest of your body. The mitral valve makes sure that blood moves forward through this pump and does not slip back the wrong way.

Mitral valve disease is the general term for any problem that stops this valve doing its job properly. In simple terms, the valve either does not open fully, or does not close fully, or both. When that happens, the heart has to work harder to keep blood moving, and over time this extra effort can tire the heart muscle.

It helps to know that this is a common condition, that it often develops slowly over years, and that many people live normal lives with it. Some people never have symptoms and only need occasional check-ups. Others, when the valve becomes more affected, benefit greatly from a repair or replacement. The aim of this guide is to explain your options clearly, not to alarm you. A heart specialist (cardiologist) is the right person to tell you which situation applies to you.

There are three main ways the mitral valve can be affected. You may have one of them, or sometimes a mix.

• Mitral regurgitation (a leaky valve). This is the most common mitral valve problem. The valve does not close tightly, so a little blood leaks backwards into the upper chamber each time the heart squeezes. Doctors often divide it into two kinds. In primary regurgitation, the valve itself is the problem — for example its flaps have become floppy. In secondary (also called functional) regurgitation, the valve is structurally fairly normal but the heart chambers around it have stretched or weakened, so the valve can no longer close neatly.
• Mitral stenosis (a narrowed valve). Here the valve has become stiff or partly stuck and does not open fully. This narrows the doorway and makes it harder for blood to flow from the upper chamber into the pumping chamber. Worldwide, the most common cause is past rheumatic fever (explained in the next section).
• Mitral valve prolapse. This is when the valve flaps are a little too floppy and bulge backwards as the heart squeezes. Many people with prolapse have no symptoms and never need treatment, but in some it can lead to a leaky valve over time.

Doctors also describe how advanced the disease is using stages, often labelled A to D, where D is the most severe. Staging simply helps the team decide whether to keep an eye on things or to plan a procedure.

Mitral valve disease has several possible causes. Knowing the cause helps your team choose the best treatment.

• Age-related wear. As we get older the valve tissue can thicken, stiffen, or build up calcium (a hardening mineral deposit). High blood pressure, high cholesterol, and smoking can add to this over the years.
• Rheumatic fever. This is an illness that can follow an untreated strep throat infection. It can scar the mitral valve, and the valve problem may only show up five to ten years later. Rheumatic fever is now uncommon in many high-income countries but remains an important cause in many parts of the world.
• Mitral valve prolapse and floppy valves. Over time, a floppy valve can start to leak.
• Infection of the valve (endocarditis). Bacteria in the bloodstream can settle on a heart valve and damage it.
• Heart muscle problems. A previous heart attack, or a weak or enlarged heart muscle (cardiomyopathy), can pull the valve out of shape and cause secondary regurgitation.
• Conditions present from birth. Some people are born with a valve that did not form normally.
• Connective tissue conditions. Inherited conditions such as Marfan syndrome or Ehlers-Danlos syndrome can affect the valve tissue.

Having a risk factor does not mean you will develop valve disease, and many people with valve disease have no obvious cause at all.

In the early stages, mitral valve disease often causes no symptoms at all. It is sometimes found by chance when a doctor hears an extra heart sound (a murmur or a click) through a stethoscope during a routine check.

When symptoms do appear, they tend to come on gradually and may include:

• Breathlessness, especially with activity or when lying flat
• Tiredness or low energy
• A fluttering, pounding, or irregular heartbeat (palpitations)
• Dizziness or light-headedness
• Swelling in the ankles, feet, or legs
• A dry cough, sometimes worse at night
• Needing to pass urine more often at night

When to see a doctor. Make a routine appointment with your doctor if you notice any of these symptoms, or if you have been told you have a heart murmur and want it checked. It is worth getting symptoms assessed early, because catching valve problems before the heart is strained gives the best results.

When to seek urgent help. Call your local emergency number if you have sudden severe chest pain, sudden severe breathlessness, fainting, or a racing heartbeat together with breathlessness. These need to be checked straight away.

There is no routine population-wide screening programme for mitral valve disease in the way there is for some cancers. Most cases are picked up in one of two ways: either because a person develops symptoms and sees a doctor, or because a clinician hears a heart murmur during an examination done for another reason.

If a murmur or click is heard, the usual next step is an echocardiogram — a painless ultrasound scan of the heart that shows the valves moving in real time. This is the single most useful test for confirming valve disease and judging how significant it is.

Some people are watched more closely because they are known to be at higher risk — for example, those with a history of rheumatic fever, a connective tissue condition, a known floppy valve, or a previous valve infection. If that applies to you, your doctor may arrange regular echocardiograms even when you feel well, so that any change is spotted early. The simple message is: if you have symptoms or a known murmur, ask for it to be looked into rather than waiting.

Diagnosis usually starts with a conversation about your symptoms and a physical examination, including listening to your heart. From there, your doctor may arrange one or more of the following tests. None of the common ones are painful.

• Echocardiogram (heart ultrasound). The main test. A small probe on the chest sends sound waves to create a moving picture of the valves and chambers. It shows whether the valve is leaking or narrowed and how severe this is.
• Transoesophageal echocardiogram (TEE or TOE). A more detailed ultrasound taken from a thin probe gently passed into the food pipe, which sits just behind the heart. This gives a very close-up view and is often used when planning a procedure.
• Electrocardiogram (ECG). A quick, painless recording of the heart's electrical activity that can show an irregular rhythm such as atrial fibrillation.
• Chest X-ray. Can show whether the heart is enlarged or whether there is fluid in the lungs.
• Cardiac MRI or CT scan. Detailed pictures of the heart's structure, sometimes used to measure the leak precisely or to plan surgery.
• Exercise (stress) testing. Checks how your heart copes with effort.
• Cardiac catheterisation. A thin tube passed through a blood vessel to measure pressures inside the heart and check the heart's own arteries; usually done when more information is needed before treatment.

Together these tests tell the team the type of valve problem, how severe it is, the stage, and whether the heart muscle has been affected — all of which guide the treatment plan.

Treatment is matched to the type of valve problem, how severe it is, your symptoms, and your overall health. Decisions are usually made by a multidisciplinary heart team — typically a cardiologist, a heart surgeon, an imaging specialist, and an anaesthetist working together — so that the plan suits you as a whole person.

Watchful monitoring. If the disease is mild and you have no symptoms, the best approach may simply be regular check-ups and echocardiograms to make sure nothing is changing. No treatment is needed unless or until it is.

Medicines. Medicines do not repair a valve, but they can ease symptoms and protect the heart. Depending on your situation these might include water tablets (diuretics) to reduce fluid build-up, drugs to control blood pressure and support the heart muscle, medicines to steady an irregular heartbeat, and blood-thinning (anticoagulant) medicines to lower the risk of clots, particularly if you have atrial fibrillation.

Repairing the valve. When possible, surgeons often prefer to repair the valve rather than replace it, because keeping your own valve has advantages. Repair can be done through traditional open-heart surgery or, in suitable cases, through smaller (minimally invasive or keyhole) incisions.

Replacing the valve. If the valve cannot be repaired, it can be replaced. There are two main kinds of replacement valve: mechanical valves, made of durable man-made materials, which last a long time but require lifelong blood-thinning medicine; and biological (tissue) valves, made from animal or human tissue, which usually do not need lifelong blood thinners but may wear out sooner. Your team will help you weigh up which suits your age and lifestyle.

Catheter-based (transcatheter) procedures. For some people, especially those for whom open surgery would be high-risk, the valve can be treated through a thin tube (catheter) passed up through a blood vessel, avoiding a large chest incision. For a leaky valve, transcatheter edge-to-edge repair (TEER, sometimes known by the device name MitraClip) attaches a small clip to help the valve flaps close better. For a narrowed valve, balloon valvuloplasty uses a balloon to gently widen the opening. In selected complex cases, the valve can also be replaced via catheter (transcatheter mitral valve replacement).

Supportive care. Alongside any procedure, treating high blood pressure, managing other heart conditions, dental care to reduce infection risk, and cardiac rehabilitation all help your heart and your recovery.

The outlook for mitral valve disease is generally encouraging, and it depends a great deal on the type and severity of the problem, on how well the heart muscle is working, and on whether and when treatment is given. Mild disease may stay stable for many years with simple monitoring. When the valve does need treatment, modern repair and replacement procedures are well established and most people see a real improvement in their symptoms and quality of life.

Two general points are worth knowing. First, the disease can progress slowly in some people and more quickly in others, which is exactly why regular follow-up matters — it lets your team act at the right time rather than too late. Second, treating a significant valve problem before the heart muscle has been strained tends to give the best results, which is one reason doctors keep a close eye even when you feel well.

It is not possible to predict any individual person's future from general information. The figures and patterns described by medical authorities describe groups of people, not you specifically. Your own cardiologist, who knows your scans and your history, is the only one who can give you a realistic picture of your situation, and is the right person to ask.

Many people live full, active lives with mitral valve disease. A few sensible habits help you stay well and stay informed.

• Keep your follow-up appointments. Regular check-ups and echocardiograms let your team track the valve over time. Tell them if your symptoms change.
• Take medicines as prescribed. If you have a mechanical valve and take blood thinners, regular monitoring and steady dosing are important. Never stop heart medicines without medical advice.
• Look after your teeth and gums. Good dental care lowers the risk of a valve infection. Some people are advised to take preventive antibiotics before certain dental work — ask your team whether this applies to you.
• Move your body. Most people are encouraged to stay active. Ask your doctor what level of exercise is right for you, especially after a procedure.
• Manage the basics. Keeping blood pressure, cholesterol, and weight in a healthy range, and not smoking, all reduce strain on the heart.
• Plan ahead for pregnancy. Pregnancy puts extra demand on the heart. Anyone with valve disease who is pregnant or planning a pregnancy should discuss it with a cardiologist beforehand.

Knowing what to watch for — increasing breathlessness, swelling, or new palpitations — and reporting it promptly is one of the most useful things you can do for yourself.

If you are thinking about having a mitral valve procedure abroad, it helps to understand that no two treatment plans are identical, which is why a personalised estimate matters far more than a generic price. Rather than quoting figures, it is more useful to know the factors that shape the cost and the plan:

• The type of procedure. A valve repair, a valve replacement, a catheter-based clip, and a balloon procedure are all different in complexity and resources.
• Open surgery versus minimally invasive or transcatheter approaches. Each uses different equipment and recovery pathways.
• The kind of replacement valve, if one is needed (mechanical or tissue).
• The pre-treatment tests required, such as echocardiograms, a TEE, CT or MRI, and catheterisation.
• Length of hospital and intensive-care stay, which depends on the procedure and your recovery.
• Other health conditions that may need managing at the same time.
• Rehabilitation, follow-up scans, and medicines after the procedure.

To prepare, gather your medical records before you travel: recent echocardiogram reports and, if possible, the image files; any ECG, chest X-ray, CT, or MRI results; a current list of your medicines and doses; a summary of your medical history and any past heart procedures; and recent blood test results. Having these ready allows a specialist to review your case properly and give you an accurate, individual plan. We are happy to arrange a free consultation to review your records and provide a personalised estimate — there is no obligation.

Turkiye has become a well-known destination for heart care, with experienced cardiac teams, modern hospitals, and established pathways for international patients. As with anywhere, the most important thing is to choose carefully and to focus on quality and transparency rather than on price alone. Here is what to look for and verify:

• Accreditation. Look for hospitals with recognised international accreditation, such as Joint Commission International (JCI), which sets standards for patient safety and quality of care.
• A genuine multidisciplinary heart team. Good valve care relies on cardiologists, cardiac surgeons, imaging specialists, and anaesthetists working together. Ask whether your case will be discussed by such a team.
• Experience with your specific procedure. Ask how often the centre performs the particular operation or catheter procedure you may need, and about their approach to valve repair versus replacement.
• Clear, written information. A trustworthy centre will explain the plan, the risks, the expected recovery, and the follow-up in writing, and will answer your questions without pressure.
• Language support and aftercare. Check what interpreting, coordination, and follow-up support is available, including how your home doctor will receive your records.

Be cautious of anyone promising a guaranteed cure or using superlatives. A reputable team talks in terms of careful assessment and realistic expectations. A concierge service can help you compare accredited centres, arrange a specialist review of your records, and organise your travel and stay.

Not all mitral valve disease can be prevented — some causes, such as being born with a valve difference or inheriting a connective tissue condition, are simply outside our control. But several steps lower your risk or slow the disease, and they are good for your heart in general.

• Treat sore throats properly. Because rheumatic fever can follow an untreated strep throat, getting throat infections checked and treated when needed helps prevent one of the world's major causes of valve damage.
• Care for your teeth and gums and tell dental and medical staff about any heart valve condition, so they can reduce the risk of valve infection.
• Keep your heart healthy. Managing blood pressure and cholesterol, staying physically active, eating well, keeping to a healthy weight, and not smoking all reduce strain on the valves and the heart muscle.
• Go to your check-ups. If you already have valve disease or a murmur, regular monitoring is the single most useful form of self-care, because it lets treatment happen at the right moment.
• Consider a second opinion. Before any major valve procedure, it is completely reasonable to seek a second specialist opinion. A good team will welcome this. It can help you feel confident that the recommended plan is right for you.

Above all, work in partnership with a qualified cardiologist. With the right monitoring and, when needed, the right procedure, most people with mitral valve disease do well.