Mitral Valve Abnormalities

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What are mitral valve abnormalities?

An abnormal mitral valve may become “floppy” and not close well (prolapse), it may allow blood to leak back from the left ventricle into the left atrium (regurgitation) or it may become narrow or tight (stenosis).

The mitral (pronounced MY-trahl) valve acts like a door in the heart. It allows blood to pass from the left atrium (which receives blood from the lungs) to the left ventricle (which pumps blood out to the body). The mitral valve has 2 flaps, also called leaflets.

There are 3 kinds of abnormalities (something that is not usual) that can affect the mitral valve:

Mitral valve prolapse is when 1 or both valve flaps do not close smoothly and may not seal tightly when the heart pumps. Instead, they may collapse backward into the atrium. Sometimes this allows blood to leak from the left ventricle back into the left atrium (regurgitation).
Mitral valve regurgitation is when the mitral valve does not close well and lets blood leak back from the left ventricle into the left atrium. This may cause the atrium to get bigger. Then the atrium cannot squeeze blood out to the ventricle as well as it should.
Mitral valve stenosis is when the valve becomes narrow or tight. This makes it hard for blood to get from the left atrium to left ventricle. Blood can back up in the blood vessels of the lungs. Valve stenosis and regurgitation can happen together.

Some valve abnormalities do not cause any problems. Others can cause serious problems, like heart failure, if they are not treated.

What causes mitral valve abnormalities?
Some children are born with mitral valve problems. In many cases, the cause is not clear. Children born with mitral valve problems may have other conditions that need treatment.
- Mitral valve regurgitation can develop in children who have holes in the walls that divide the upper or lower heart chambers (atrial septal defect, ventricular septal defect or atrioventricular septal defect).
- Congenital mitral valve stenosis is usually linked with conditions that block blood flow on the left side of the heart. Rarely, mitral valve stenosis can happen on its own.
- Some children with congenital (present at birth) mitral valve problems are born with other conditions too. For instance, mitral valve prolapse sometimes happens with Marfan syndrome, and some types of mitral valve regurgitation are common in children with Down syndrome.
Some children begin life with a normal mitral valve and then develop problems later on. One cause of mitral valve problems is rheumatic fever, which happens after a strep infection.

Heart Center at Seattle Children's

Our pediatric cardiologists and cardiac surgeons have more advanced training and experience operating and performing procedures on babies, children and teens than at any other children's hospital in the Pacific Northwest.

Symptoms of Mitral Valve Abnormalities

Mitral valve abnormalities may cause no symptoms for many years.

Your child may have some of these symptoms, depending on the valve problem and how severe it is:

Feeling short of breath when active or lying down
Coughing
Feeling more tired than normal
Having palpitations
Having an arrhythmia

Some babies with mitral valve abnormalities may also have symptoms like these:

Fast breathing or working hard to breathe
Trouble eating or gaining weight (failure to thrive)

Diagnosing Mitral Valve Abnormalities

To diagnose a problem with the mitral valve, your child’s doctor will examine your child. The doctor will use a stethoscope to listen for abnormal sounds in their heart (a murmur) or the sound of a valve not closing well. Sometimes doctors find valve problems after hearing a heart murmur in a child who appears well.

Your child will need an echocardiogram so the doctor can see how their heart is working.

They may need other tests that provide more information about their heart. These include:

Electrocardiogram
Chest X-rays
MRI (magnetic resonance imaging) of the heart
Cardiac catheterization
Exercise testing

Treating Mitral Valve Abnormalities

Treatment for mitral valve abnormalities depends on the type of problem and how it affects your child.

Many children with mitral valve abnormalities do not need treatment. Even so, they do need regular visits with a pediatric cardiologist.

During these visits, we carefully check your child for signs that their condition is getting worse and might need treatment soon. It is important to watch for problems, even before symptoms start, so we can find and treat any concerns before they become severe.

Seattle Children’s Heart Center team is expert at all forms of treatment, including the latest methods to repair or replace mitral valves.

Mitral valve prolapse treatment

Most children with mitral valve prolapse do not need treatment because their valve causes no symptoms or problems. If they do have symptoms, like palpitations or chest pain, they may need medicine to relieve these.

In uncommon cases, when a prolapsed valve causes major regurgitation, a child may need surgery to repair or replace the valve.
Mitral valve regurgitation treatment

Depending on how severe it is, this valve problem may be treated with medicine that helps the left ventricle pump better so less blood leaks back into the left atrium. If medicine does not help enough, your child may need surgery to repair or replace their mitral valve.

Mitral valve regurgitation may lead to an arrhythmia. If this happens, your child may need medicines that help control their heartbeat.
Mitral valve stenosis treatment

If mitral valve stenosis is not treated, blood pressure in the lungs may get too high. This is called pulmonary hypertension. It can cause permanent damage to the lungs and the heart, including heart failure.

To prevent damage, some children can have a procedure to open their mitral valve. We do this in the catheterization lab. The doctor inserts a balloon through the valve. When they inflate the balloon, it stretches the valve open. Then they remove the balloon. This is called balloon valvuloplasty.

Some children may need surgery to replace their mitral valve.

Research and Clinical Trials

Seattle Children’s took part in research that led the U.S. Food and Drug Administration to approve the St. Jude mechanical heart valve. At only 15 millimeters (mm) across, it is small enough to be placed in babies who need a new mitral valve. Because of our role in research, we were among the first in the nation to use 15-mm valves, and we have more experience placing them than most other centers.

For babies who need an even smaller option, we also use modified Melody valves, which we can enlarge as the child grows. Our researchers are studying other new “growth valves” that can take the place of an abnormal mitral valve and be enlarged over time.

Mitral Valve Abnormalities at Seattle Children’s

The experts you need are here
- Seattle Children’s team of 40+ pediatric cardiologists diagnose and treat mitral valve abnormalities in children of all ages, from infants to adolescents.
- Our pediatric cardiac surgeons perform more than 500 procedures yearly. Each has deep experience operating on children who need a heart valve repaired or replaced – even young babies.
- We also have a pediatric cardiac anesthesia team and a Cardiac Intensive Care Unit ready to care for children who undergo heart surgery.
- For children with mitral valve stenosis, we are leaders in providing safe and effective catheterization procedures. Typically, these procedures are less painful and have shorter recovery times than surgical treatments.
Among the nation’s top programs
- See our statistics and outcomes for mitral valve repair and replacement.
Care from birth through young adulthood
- We match your child’s care to their symptoms, and we take into account their age, growth and development. Some children with mitral valve abnormalities need no treatment. Others need medicines or heart valve repair or replacement. Your child’s treatment plan is custom-made for them.
- If your child was born with valve abnormalities, we have a special Adult Congenital Heart Disease Program to meet your child’s long-term healthcare needs. This program, shared with the University of Washington, transitions your child to adult care when they are ready.
Support for your whole family
- We are committed to your child’s overall health and well-being and to helping your child live a full and active life.
- Whatever types of care your child needs, we will help your family through this experience. We will discuss your child’s condition and treatment options in ways you understand and involve you in every decision.
- Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age.
- Seattle Children’s has many resources, from financial to spiritual, to support your child and your family and make the journey as smooth as possible.
- Many children and families travel to Seattle Children’s for heart surgery or other care. We help you coordinate travel and housing so you can stay focused on your child.
- Read more about the supportive care we offer.
Research to improve care
- Doctors and scientists at Seattle Children’s are working to advance treatment for mitral valve abnormalities and enhance the quality of life for children who need treatment for valve problems.
- Our surgeons are among the most experienced in the nation with the 15-millimeter St. Jude mechanical valve – small enough for babies – due to our role in clinical trials that led to the U.S. Food and Drug Administration to approve this device.
- For very small babies who need an even tinier option than the St. Jude valve, we are on the leading edge. We offer a Melody valve modified so a surgeon can place it. Usually, a Melody valve is used to replace a different heart valve, the pulmonary valve, and it is placed by cardiac catheterization. Our cardiac surgeons can use modified Melody valves to replace the mitral valve in babies. Then, as the child grows, our catheterization specialists can enlarge the Melody valve to match the child’s needs until their heart is big enough to receive a larger valve. We are also involved in research to develop more “growth valves” – devices that can be placed in small babies and enlarged as they grow.