Mitral Regurgitation - Mild, Moderate Or Severe?
I just received an email from Tamara about diagnosing mitral valve regurgitation.
She writes, “Hi Adam - I was just diagnosed with moderate-to-severe mitral valve regurgitation. I’m an active, 64 year-old grandma that never even knew I had a heart valve problem. My cardiologist doesn’t believe I need surgery right away. Instead, he wants to monitor my mitral valve prolapse every six months with more echocardiograms. I’m curious to know, what distinguishes moderate regurgitation from severe regurgitation? Thanks, Tamara.”
Tamara raises an interesting point about diagnosing mitral regurgitation. Similar to other valvular diseases (e.g. aortic stenosis), there are three common categories by which regurgitation is defined. Those categories are mild, moderate and severe.
According to Dr. David Adams, a mitral valve specialist at Mount Sinai Hospital, the two main determinants in quantifying mitral regurgitation are:
- Regurgitation volume (RVOL): the difference between the mitral and aortic stroke volumes); and
- Effective regurgitant orifice (ERO): ratio of regurgitant volume to regurgitant time velocity integral
The table below shows how regurgitation volume and effective regurgitant orifice measurements are used to diagnose mitral regurgitation in patient’s with degenerative mitral disease.
Mitral Regurgitation Grading (Source: Dr. David Adams)
While traditional, two dimensional echocardiography with doppler is essential to determine the severity of mitral regurgitation, your cardiologist may elect to use transesophageal echocardiography (TEE) to confirm the diagnosis.
As you may be aware, mitral valve regurgitation is a relatively common valvular disorder. According to The Cleveland Clinic, about 2% of the population have mitral regurgitation.
I hope that helps Tamara (and perhaps you) better understand how mild, moderate and severe mitral regurgitation is diagnosed.
Keep on tickin!
P.S. To leave a comment, please click here.
About The Author: Adam Pick is a double, heart valve surgery patient and author of The Patient’s Guide To Heart Valve Surgery. This unique book integrates the clinical facts of heart valve surgery with the personal experiences of 135 former valve surgery patients to help patients and caregivers better understand the opportunities and challenges of heart valve surgery. To learn more about Adam and his heart valve surgery book, click here.
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May 9th, 2009 at 4:53 pm
Tamara,
As background, I was diagnosed with a heart murmur during a routine physical in April 1999. After an echocardiogram, they told me I had a “moderate to severe” mitral valve prolapse. Prior to being diagnosed, I ran numerous marathons and never had, and still do not have, any symptoms.
Like yours, my doctor also suggested monitoring it which we did for the last ten years. Over time, my mitral valve prolapse category changed to “severe”. This past year, they recommended surgery to repair the valve which I am now scheduled for this coming week on 5/13/09. I am nervous about it but I have checked this out with several doctors and they all think proceeding wit the repair is the best for my situation.
I would recommend a couple things if you have not done so already. One is to obtain a copy of your echocardiogram and office visit reports from the doctor. While they can be technical and complicated to understand, I have found them to be helpful to better understand my valve disease and be able to ask more informed questions. Another recommendation would be to get a second opinion. For example, there are a lot of other factors than just the different categories or grades and too many to list in an e-mail. The second opinion really helps to better understand all the information for your particular situation.
I hope this helps and best of luck to you!
Dan
P.S. Adam, Thank you for the great website and book. They have been very helpful to me and my wife as we prepare for my upcoming sugery. Thank you! Dan
May 9th, 2009 at 5:11 pm
As Adam stated, the TEE test is the definitive test to determine the degree of your regurgitation. What Adam didn’t really mention is that the TEE is an ultrasound test like an echo cardiogram except they put you to sleep and drop the ultrasound generator down your Esophagus. It’s no big deal except you can expect to have a raspy throat for a couple of days. Is it necessary and bearable? Yes! Will you have an irritated throat/ Yes. Is it worth it? YES!
May 16th, 2009 at 3:36 pm
Hi, I was diagnosed with MVP at 12y/o. Never had any problems or symptoms until recently. In Feb. at a routine check-up my murmur sounded louder then usual and I was referred to a cardiologist. After echo, EKG and TEE he felt my regurgation was moderate to severve with atrial enlargement and recommened surgery within 6 mos. I saw a surgeon and he ran his own echo and MRI and determined that I had moderate regurgation. He didn’t feel surgery was warranted at this time. The whole experience has been extremelly frustrating. I now am waiting for another appt. with my cardiologist to see where we go from here.
My question to others, have you had a similar experience and do you have symtoms?
For the last 6-8 mos. I have had fatigue, some SOB with bending over and any increased activity that envoles moving my arms, like mopping.
Also, this is not everyday that I feel bad, I have learned what causes the sx and just modify my activities.
I would appreciated hearing from anyone with similiar symtoms or experience. Thank you! Sharon
May 22nd, 2009 at 4:29 pm
Sharon, I was diagnosed with severe with no symptoms. I put off surgery despite recommendations that I should have right away. I kept thinking..I don’t have symptoms, so I can wait a little longer. The thing was, during this whole time I was always thinking about it and it weighed me emotionally. Low and behold within a few months of diagnosing, I started having symptoms. I had to take rests and a nap everyday and just felt tired all the time. I still refused to believe I was having symptoms and was in denial. My wife was the one that finally brought to my attentions how far my quality of life had decreased. Others see it much more than you. I am now 7 weeks post-op and have had a pretty good recovery, however I also now realize it will take sometime to be 100percent. The biggest change, the stress that has been lifted off my shoulders because I finally went ahead and had it done!!!
May 23rd, 2009 at 11:57 pm
Hi, I was born with an unusual heart murmur that was not able to be diagnosed until I was in my late 30’s, when the echocardiogram became available and I was told I had MVP. Also told that there was no treatment and to just “live my life” as I did not have a diseased heart. Later, in my 40’s I developed more arrythmia symptoms that were managed by beta blockers. I had a full life. Fast forward to my 70th year. I had celebrated my 70th birthday by “flying” in a verticle wind tunnel (like skydiving), did parasailing a few months later, was building stone walls in my garden, and keeping up with my grandchildren. Gradually I noticed I needed a short nap more frequently, but did not think it more than normal aging. Last spring I asked for a repeat echocardiogram just because I wanted to know that my heart was still healthy. I was shocked to be told that my MVP had gone from moderate regurgitation to “significant” with a recommendation for followup with a TEEand that I was a candidate for Mitral Valve repair surgery “sooner rather than later” in order to be able to avoid MV replacement.
In doing my research, I read the recommendations of the American College of Cardiology for Mitral Valve Prolapse treatment, revised in 2006. They reported that MV repair has been shown to be so superior to replacement that they are urging cardiologists to recommend repair surgery when the regurgitation gets to “significant” and not wait for further worsening. And they recommended that cardiologists refer patients to centers of excellence in MV repair, who do a high volume of MV repair, and to a surgeon who is an expert in repair surgery, having done 100-200 surgeries with a committment to repair.
By the time I had my TEE 3 weeks later, my MVRegurg had worsened to severe and I was having lots of symptoms - chest pain, shortness of breath, fatigue, lack of mental clarity, swelling feet, etc. Second, third, and fourth opinions, lots of research, reading Adam’s book, were all helpful in educating me and preparing me for a very successful Mitral Valve repair last Sept 2008, minimally invasive, with the DaVinci robot assisted approach.
Learning about CoQ10 and heart supplementation thanks to Dr Stephen Sinatra’s website and books have been very helpful in preparing for surgery and in recovery.
Learn as much as you can, keep copies of your records (they get purged form hospital records every 7 years, I learned), be proactive, be aware that stable MVP can take a sudden turn for the worse, and that the options for treatment are improving rapidly. Mitral Valve Repair surgery was invented only 15 years ago, minimally invasive approaches are relatively new and improving all the time, the DaVinci robotic assisted approach for MV Repair was about 2 years old when I had it. Just 2 weeks ago the news reported enhanced optics for the robot - it is not only 3-D, but now HD also, so the surgeon’s view of the valve is greatly enhanced. Who knows, maybe in the future MV repair will be an OP procedure! HA!
I am very happy with my results so far. It does take awhile to totally heal. I pay a price when I overdo and don’t pace myself, and am enjoying more energy than I can remember having before. Also, I realize now that I had gradually been giving up interests and activities as I was compensating for the gradual decreasing functioning of my MV. I love that my brain is now functioning, and can see the difference of the past several years.
Winona
February 5th, 2010 at 7:05 pm
Hi! I was diagoniased with moderate mitral valve regurgitation in November 2007. I was doing a routine medical check-up for a visa I was applying for. and the doctor heard a murmer and referred me for an echocardiogram. I had no symptons and was shocked. The cardiologist advised a yearly check-up. In January 2010 I was told that it has progressed to severe but since I have no symptoms I do not require surgery yet. However my ankles and legs are swollen. I sometimes have a slight pain on my left shoulder at the base of my neck. Is this a sympton. Does anyone reading have the regurgitation progress so quickly? How long before they decide it is bad? Please respond.