THE heart pumps blood throughout the body ceaselessly. It has four chambers that fill and push out blood, with valves working like one-way gates to ensure that blood flows in only one direction without backflow.
But sometimes, these valves fail to close properly, allowing blood to leak backwards. Cardiac Vascular Sentral (Kuala Lumpur) consultant cardiologist Dr Al Fazir Omar explains that mitral regurgitation (MR) occurs when the mitral valve, which separates the left upper chamber (atrium) and left lower chamber (ventricle), does not close tightly. This means the heart must work harder to pump blood throughout the body, eventually leading to enlargement and weakening of the heart muscles.
MR is among the most common types of valve disease, particularly in older adults. “The incidence can rise as we grow older,” says Dr Al Fazir. “This is due to age-related wear and tear of the valve as we age. However, the condition can also occur in younger individuals due to congenital valve abnormalities, rheumatic heart disease, infections affecting the heart valves, or complications following a heart attack,” he adds.
Hypertension, coronary artery disease, heart arrhythmias and certain autoimmune conditions can also increase one’s risk. While MR often develops slowly over years, it can sometimes occur suddenly – for example, after a heart attack or an injury to the valve, observes Dr Al Fazir.
Symptoms of MR may at first be subtle. “Patients may notice breathlessness, especially during physical activity or when lying down,” says Dr Al Fazir. “They might also experience fatigue, palpitations, or swollen ankles. Eventually, they may experience severe breathlessness even at rest when the valve deteriorates. However, some people have no symptoms for years, with the condition detected only during a routine check-up.”
Quite often, symptoms of MR often resemble those of other problems such as lung disease, a blocked vessel in the heart, or other conditions. Dr Al Fazir advises that if you notice symptoms such as breathlessness and increasing fatigue, it’s best to get it checked by a doctor “as soon as possible. Do not ignore such symptoms.”
Diagnosing and managing MR
MR can be diagnosed through auscultation, where the doctor hears a characteristic murmur that indicates a valve problem, and confirmed through an echocardiogram, which uses ultrasound to show how the valve is working and how much blood is leaking. In some cases, doctors may also order additional imaging or blood tests to assess the severity and impact on heart function.
According to Dr Al Fazir, MR is usually a progressive condition. “Eventually, the heart gets more dilated, leading to more severe symptoms. Do take note that not all cases of mitral regurgitation require immediate intervention. Mild cases may simply be monitored with regular follow-ups and medications. But if it becomes moderate or severe, further treatment is needed to prevent complications such as heart failure or irregular heart rhythms,” he advises.
The decision to treat depends on the degree of leakage, symptoms, and overall heart function. Traditionally, this meant open-heart surgery to repair or replace the damaged valve. However, for many patients today, less invasive options are available.
Rise of clip-based repair
One of the most significant advances in recent years is clip-based mitral valve repair, or transcatheter edge-to-edge repair (TEER).
“This minimally invasive technique allows us to fix the leaky valve through a small puncture in the leg vein, without the need for open-heart surgery,” explains Dr Al Fazir.
During the procedure, a catheter is guided to the heart, and a tiny clip is attached to the mitral valve’s leaflets to help them close more effectively. “It’s particularly useful for older patients or those with other health problems who are not good candidates for surgery. However, there are certain criteria that need to be fulfilled before a patient is considered for the procedure,” he adds.
Most patients experience short hospital stays, fast recovery and improved symptoms within weeks after the procedure. Long-term studies have shown significant benefits and durability of the clip repair.
Ultimately, awareness and timely action can make all the difference. As expertise and technology continue to improve and advance, conditions like mitral regurgitation are increasingly treatable – often without the need for major surgery.
KKLIU: 0898 / EXP 31.12.2028
