What is mitral insufficiency?

What is mitral insufficiency?

Mitral insufficiency is a valve disease in which the mitral valve leaflets do not close properly. As a result, blood is constantly flowing in the opposite direction, which keeps the heart muscle under constant strain. Over time, the condition can lead to many complications, including atrial fibrillation (an arrhythmia that disrupts the regular rhythm of heartbeat), increased heart size, and congestive heart failure.

Patients call it heart valve failure. Mitral valve prolapse is the most common anatomic defect that causes mitral valve failure.

As can be seen in the figure below, the flaps of the valve do not close completely. As a result, blood flows in the opposite direction, forcing the heart muscle to "pump" the same blood all over again.

One in five people over the age of 55 has some degree of mitral valve insufficiency. There are different degrees of diagnosed lesion as with most valve defects. The main diagnostic degrees of mitral insufficiency are: mild, moderate and severe.

What are the main symptoms of mitral valve insufficiency?

Symptoms of mitral insufficiency usually begin to appear as the heart defect progresses. Usually, mitral insufficiency develops slowly over many years.

The main symptoms of mitral insufficiency are:

  • Shortness of breath while moving or sleeping
  • Rapid fatigue on movement
  • Coughing at night (in bed)
  • Rapid heartbeat (sometimes atrial fibrillation)
  • Swelling of the legs or ankles
  • Polyuria

Patients should be warned that although mitral insufficiency may be asymptomatic, in some cases it can progress very rapidly. Recently, a patient with rapid degeneration (damage) of the mitral valve came to us. In just six months, her disease progressed from moderate to severe insufficiency.

If you have been diagnosed with mitral valve prolapse or insufficiency, you should have regular annual checkups. As a physician, I recommend that you properly monitor the course of this disease.

Degrees of severity of mitral insufficiency

A stethoscope can help detect mitral valve insufficiency. Echocardiography (EchoCG) is the "gold standard" for determining the severity of the disease. We would like to provide information on 2 factors that determine the severity of mitral insufficiency:

  • Regurgitation Volume (RVOL).
  • Effective Regurgitant orifice area (ERO)

To help you understand, the table below shows how Regurgitation Volume (RVOL) and Effective Regurgitant Orifice Area (ERO) are used to determine the severity of mitral insufficiency in symptomatic patients.

Degree of mitral insufficiency

RVOL (ml)

ERO (mm2)










Transesophageal echocardiography (a method of diagnosing the heart through the esophagus, which is performed under anesthesia), cardiac MRI (magnetic resonance imaging of the heart), stress-EchoCG and cardiac catheterization are used to determine the severity of valve failure, heart lesion and type of surgical treatment. One or more of the above methods can be used for diagnosis.

When should surgery be performed?

It should be noted that the diagnosis of mitral insufficiency (or mitral valve prolapse) does not mean that you need open heart surgery. Considering that the disease usually progresses slowly, most mitral valve surgeries are elective operations to repair the mitral valve or to replace it with a new artificial valve. In most cases, surgical treatment for mitral insufficiency is performed when a patient is diagnosed with severe insufficiency. Although some clinicians argue that surgery is only necessary when symptoms are present, 3 out of 4 recent studies have shown that asymptomatic patients with severe mitral insufficiency require early surgical intervention to maintain ventricular function and prevent further damage to the heart muscle.

Mitral Valve Reconstruction - Annuloplasty

Once again, I recommend that all patients diagnosed with mitral valve prolapse or insufficiency have annual examinations and echocardiography (if necessary). If this defect is not treated in time, complications can be very dangerous.