Doctors classify mitral valve regurgitation into four progressive stages. Symptoms typically don’t appear until the final stages but monitoring and treatment in earlier stages may help slow progression.
Mitral regurgitation, or mitral valve regurgitation, is when your mitral valve doesn’t properly close and blood flows backward through your heart. Your mitral valve is located between the two chambers on the left side of your heart.
Guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) divide mitral regurgitation into four stages — A to D — depending on the severity of its signs and symptoms. Stage A is the least severe and stage D is most severe.
Let’s examine each of the stages of mitral valve regurgitation more closely.
Mitral valve and heart anatomy
Your heart comprises four chambers: two upper chambers called atria (singular: atrium) and two lower chambers called ventricles.
Your mitral valve is located between your left atrium and left ventricle. It comprises several structures that can become damaged, including :
- Leaflets: two structures that open and close to let blood through
- Mitral annulus: a fibrous ring that acts as the leaflet insertion site
- Chordae tendineae (chords): fibrous strings that pull open the leaflets
- Papillary muscles: muscles that pull on chordae tendineae to open your leaflets
Stage A mitral regurgitation: At risk
Stage A mitral regurgitation is the least severe . People in this stage are at risk of developing mitral regurgitation.
People in stage A have:
- no symptoms
- no related structural changes in their heart due to changes in blood flow
- typical leaflets, chords, and annulus in the presence of coronary artery disease or cardiomyopathy
- very small amount of mitral regurgitation
Treatment
You likely won’t need treatment for Stage A mitral regurgitation. Still, a doctor may want to monitor your condition regularly and recommend lifestyle changes to support your overall heart health, such as:
Stage B mitral regurgitation: Progressive
Progressive mitral regurgitation is the second least severe stage. People in this stage still don’t have symptoms, but they have a higher degree of blood volume flowing backward into their left atrium.
People in stage B might have:
- mild left atrial enlargement
- mild mitral regurgitation
- no left ventricular enlargement or change in the blood vessels leading to the lungs
- mild to severe mitral valve prolapse , meaning the mitral valve buckles inward into the left atrium
- mild restriction of the mitral valve leaflets and increased mitral annulus size
Treatment
Stage B mitral regurgitation also doesn’t generally need any treatment. Like with stage A, a doctor will likely want to monitor your heart regularly and may recommend lifestyle changes.
Stage C mitral regurgitation: Asymptomatic severe
Stage C mitral regurgitation also doesn’t cause symptoms but causes severe mitral regurgitation. People in this stage may have:
- severe mitral valve prolapse
- thickening of the leaflets, possibly due to an infection or chest radiation therapy
- valve inflammation with leaflet restriction
- severe mitral regurgitation
- moderate or severe left atrial enlargement
- left ventricle enlargement
- pulmonary hypertension at rest or with exercise
Doctors can divide stage C into stages C1 and C2 based on the degree of change to your left ventricle.
Treatment
ACC/AHA guidelines recommend surgery for people with stage C2 disease. Such surgeries involve either repairing or replacing the mitral valve .
Experts recommend mitral valve repair over mitral valve replacement when possible.
Stage D mitral regurgitation: Symptomatic severe
People in stage D have features similar to people in stage C but with increased severity and symptoms. People with stage D mitral regurgitation may have symptoms that include:
Treatment
Experts recommend mitral valve surgery for people with stage D mitral valve regurgitation. People at a high risk of surgical complications may undergo a procedure called transcatheter edge-to-edge repair.
How do doctors determine the mitral regurgitation stage?
Doctors use a variety of tests to determine your mitral regurgitation stage. These can include:
What is the life expectancy with mitral regurgitation by stage?
Mild mitral regurgitation might not cause any problems or affect your life span.
In a 2018 study of 83 people with an average age of 57 and experiencing no symptoms, researchers found that people who underwent mitral valve repair had survival rates comparable to people in the larger population. The early death rate in the study was 0%.
Experts generally associate mitral valve repair with better survivability than mitral valve replacement.
Frequently asked questions
How do you know if mitral regurgitation is getting worse?
Mitral regurgitation doesn’t cause symptoms until you reach stage D. Progressively worsening symptoms or the development of new symptoms can be a sign you have increased regurgitation.
How fast does mitral regurgitation progress?
The rate at which mitral regurgitation progresses depends on many factors. Experts recommend people with mitral valve prolapse undergo monitoring every 3 to 5 years , while those with mitral regurgitation should undergo monitoring yearly.
What worsens mitral valve regurgitation?
Lifestyle habits, like not taking steps to control blood pressure and consuming a lot of tobacco or alcohol, can contribute to the development of heart valve disease.
Takeaway
Doctors divide mitral valve regurgitation into four stages, A to D. Symptoms typically don’t appear until stage D.
A doctor is most likely to recommend surgery for mitral valve regurgitation if you’re in stage C2 or stage D. Research links mitral valve repair to better survival than mitral valve replacement.
If you receive a mitral valve regurgitation diagnosis, it’s important to visit a doctor regularly to monitor whether your condition is getting worse.
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