Mitral Valve Disease: Symptoms, Types, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Mitral valve disease is a group of conditions that affect the mitral valve, the "door" between the left atrium and left ventricle of your heart. The main forms are stenosis, prolapse and regurgitation. You may have no symptoms at all, but some people have serious symptoms that affect quality of life, and severe cases need treatment to prevent complications such as heart failure [1].
Quick Answer: What is mitral valve disease?
Mitral valve disease is a group of conditions in which the mitral valve does not work as well as it should, including stenosis, prolapse and regurgitation. Symptoms can include breathlessness, fatigue, palpitations and leg swelling, and echocardiography is the gold standard test. Treatment ranges from none to valve surgery. Call 911 for chest pain, fainting or sudden severe breathlessness. [1]
What the research says
In some patients with heart failure and a leaky mitral valve, transcatheter repair plus medical therapy beat medical therapy alone. In the COAPT randomized trial of 614 patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite maximal medical therapy, heart failure hospitalizations over 24 months were 35.8% per patient-year with the device versus 67.9% with medical therapy alone (hazard ratio 0.53; 95% CI 0.40 to 0.70). Death from any cause was 29.1% versus 46.1% (hazard ratio 0.62; 95% CI 0.46 to 0.82) (Stone et al., N Engl J Med, 2018 [2]).
Not every trial found a benefit, so patient selection matters. In the MITRA-FR randomized trial of 304 patients with severe secondary mitral regurgitation and reduced ejection fraction, the 12-month rate of death or unplanned heart failure hospitalization was 54.6% with percutaneous repair plus medical therapy versus 51.3% with medical therapy alone (odds ratio 1.16; 95% CI 0.73 to 1.84; P=0.53) (Obadia et al., N Engl J Med, 2018 [3]).
Rheumatic heart disease, a major cause of mitral stenosis, remains a heavy burden in some regions. The Global Burden of Disease study estimated 33.4 million cases and 319,400 deaths from rheumatic heart disease in 2015. Age-standardized mortality fell by 47.8% between 1990 and 2015, but the highest rates were in Oceania, South Asia and central sub-Saharan Africa (Watkins et al., N Engl J Med, 2017 [4]).
What is mitral valve disease?
Your mitral valve is made of two strong flaps of tissue called leaflets or cusps. They open and close in a coordinated rhythm to let blood flow from your left atrium into your left ventricle, like traffic directors that let a few cars through at a time and then pause traffic. These two chambers hold oxygen-rich blood from your lungs and pump it out to your body. When the valve is diseased or damaged, it can slow blood flow or let blood leak in the wrong direction [1].
Mitral valve disease can be acquired or congenital, and it can be mild, moderate or severe. Some people have more than one form, some also have problems with other heart valves, and it can occur alongside other cardiovascular problems such as coronary artery disease [1].
What are the three forms of mitral valve disease?
Mitral valve disease takes three forms: stenosis narrows the valve, prolapse makes the flaps bulge, and regurgitation lets blood leak backward.
Form | What happens | Effect on blood flow |
Mitral valve stenosis | The flaps become thick and stiff, narrowing the valve opening. | Makes it harder for blood to get through. |
Mitral valve prolapse | The flaps become too stretchy and bulge into the left atrium. | Prevents the valve from closing as well as it should and sometimes leads to regurgitation. |
Mitral valve regurgitation | The flaps are pulled apart and cannot close all the way (also called a leaky valve or mitral insufficiency). | Some blood leaks backward into the left atrium. |
Stenosis narrows the valve, prolapse makes the flaps bulge, and regurgitation lets blood leak backward.
Who it affects and how common it is
Mitral valve disease affects people of all ages. Some babies are born with mitral valve problems, some adults are affected suddenly because of a heart infection or a heart attack, and most adults develop it over time as the valve slowly deteriorates. Mitral valve prolapse is more common in women, but it seems more dangerous in men, who are more likely to have prolapse that leads to severe regurgitation [1].
Mitral valve stenosis is the least common form in the U.S., affecting about 1 in 100,000 people, and is more common in countries with higher rates of rheumatic fever. Mitral valve prolapse affects as many as 1 in 33 people in the U.S., although not all of them develop significant leaks. About 1 in 10 people in the U.S. have a leak in one of their valves, and most of those have a leaky mitral valve [1].
What are the symptoms and warning signs of mitral valve disease?
Mitral valve disease symptoms depend on the form and sometimes on the severity, and some people have no symptoms at all. You may have no symptoms at all. If you do, they can include [1]:
Chest pain
Cough, or coughing up blood
Dizziness or fainting
Fatigue
Heart palpitations, which can feel like bursts of rapid heartbeat or an awareness of your heartbeat
Migraines
Mitral facies, a plum-colored flush in your cheeks
Orthostatic hypotension (blood pressure that drops too low when you stand up)
Shortness of breath
Swelling in your legs, ankles or feet
Other conditions, such as atrial fibrillation and heart failure, can also affect your symptoms [1].
What causes mitral valve disease, and who is at risk?
There are many possible causes [1]:
Congenital heart defect: some people are born with mitral valve disease, and babies with life-threatening defects need surgery right away.
Connective tissue disorders: such as Marfan syndrome and Ehlers-Danlos syndrome.
Endocarditis: an infection in your heart.
Enlargement of the left ventricle: usually due to a heart attack or cardiomyopathy.
Getting older: calcium can slowly build up on heart valves, which for many people causes only mild or moderate mitral valve stenosis.
Radiation therapy: people who had radiation to the chest have a higher risk of valve damage, usually showing up 10 to 20 years later.
Rheumatic fever: when untreated, this infection can damage heart valves years or decades later. It is the most common cause of mitral valve stenosis, but modern antibiotic use has greatly reduced the problem in the U.S. and many other countries.
Aging, infections, congenital defects and heart events can all damage the mitral valve.
How is mitral valve disease diagnosed?
Diagnosis starts with a physical exam and tests. Your provider listens to your heart with a stethoscope for sounds linked to each form, and asks about your medical history and risk factors [1].
Form | What your provider may hear |
Mitral valve stenosis | A murmur as blood passes through and a snapping sound when the valve opens. |
Mitral valve prolapse | A clicking sound and then a murmur, which is why it is also called click-murmur syndrome. |
Mitral valve regurgitation | A murmur as blood leaks the wrong way into the left atrium. |
Echocardiography, which uses ultrasound to check for valve disease and other heart problems, is the gold standard for diagnosing mitral valve disease. Your provider may also recommend [1]:
Electrocardiography (ECG): shows your heart's electrical activity.
Chest X-ray: shows whether your left ventricle is enlarged or fluid is building up in your lungs.
Cardiac catheterization: measures pressures within your heart and can show mitral valve stenosis, and is also used before surgery to check for coronary artery disease.
What are the treatment options for mitral valve disease?
Mitral valve disease treatment depends on your symptoms, and people with no symptoms may not need treatment. If you have no symptoms, you may not need treatment. Options include [1]:
Balloon valvotomy: a catheter-based procedure for mitral valve stenosis in which a balloon at the tip of a catheter is inflated at the valve to create more room between the flaps.
Medication: diuretics, beta-blockers and calcium channel blockers can help manage blood pressure, reduce swelling and slow a heart rate that is too fast. Your provider may also recommend blood thinners to lower the risk of blood clots.
Mitral valve repair surgery: most doctors prefer this over replacement whenever possible, because it lets you keep your valve and avoid some complications of replacement.
Mitral valve replacement surgery: sometimes replacing the valve is necessary.
Minimally invasive mitral valve repair: smaller incisions and a quicker recovery, using methods such as a right mini-thoracotomy, partial upper sternotomy or robotically assisted repair.
Percutaneous interventions: catheter-based procedures that are often a good fit for people with an enlarged heart, a weak heart or other health problems. For mitral regurgitation, you may be a candidate for a MitraClip device.
Percutaneous mitral valve replacement: in some cases where surgery would be high risk and it is anatomically feasible, a new valve is expanded inside the diseased valve.
Your treatment plan depends on the form of disease you have, your age, your health history and current condition, and whether other heart problems need to be repaired at the same time. Surgeries and procedures are generally very successful with a low risk of complications, which can include arrhythmia, bleeding, blood clots, heart attack, heart block and infection [1].
Treatment ranges from monitoring and medication to repair or replacement.
What is the outlook for mitral valve disease, and can it be prevented?
Life expectancy depends on the form of mitral valve disease, how severe it is, how much it has harmed your heart and when you receive treatment [1].
Valve diseases often cannot be prevented, but you can lower your chances of developing valve disease as you get older by [1]:
Keeping a healthy weight to support the health of your heart and blood vessels
Taking prescribed antibiotics for strep throat or scarlet fever, for as long as instructed
Visiting your healthcare provider for a checkup each year
If you are pregnant or planning a pregnancy, your provider will likely advise avoiding smoking and tobacco, alcohol and recreational drugs, especially cocaine, to lower your baby's risk of congenital heart defects. Genetic testing may be a good idea if you have a family history of congenital heart disease or connective tissue disorders [1].
How can people live well with mitral valve disease?
Living with mitral valve disease means seeing your provider right away about any symptoms, since catching problems early can help you avoid serious complications. Keep your routine visits, which may monitor a mild valve problem or follow up on a repair or replacement [1]. In general it is important to [1]:
Take your medications as prescribed
Take care of your teeth and gums
Follow your provider's guidance on how often and how intensely to exercise
Avoid smoking, alcohol and recreational drugs
Manage stress and get enough sleep
Tell all your healthcare providers, including your dentist, that you have valve disease, because you may need antibiotics before certain dental or medical procedures. Carry an up-to-date medical information card that lists your valve condition, whether you have had a repair or replacement, and whether you take blood thinners [1].
When to get help right away: call 911 or your local emergency number for chest pain, fainting, dizziness or extreme weakness, a fast or irregular heartbeat, sudden and severe shortness of breath, or an unexpected medication side effect. If you take blood thinners and fall, seek care right away, because internal bleeding can be fatal even if you feel fine [1].
What is the bottom line on mitral valve disease?
Mitral valve disease affects everyone differently. You may have no symptoms and not know you have a valve problem, or you may have symptoms that affect your daily life. Visit your provider for regular checkups and report any new or changing symptoms. Valve disease often cannot be prevented, but following heart-healthy guidelines can help keep your valves and your whole heart as healthy as possible [1].
Frequently Asked Questions
What is mitral valve disease?
Mitral valve disease is a group of conditions affecting the mitral valve, which lets blood flow from the left atrium to the left ventricle. When the valve is diseased or damaged, it cannot work as well as it should [1].
What are the three main types of mitral valve disease?
Mitral valve stenosis (a narrowed valve), mitral valve prolapse (flaps that bulge into the left atrium) and mitral valve regurgitation (a leaky valve) [1].
Can you be born with mitral valve disease?
Yes. Some babies are born with mitral valve problems, which can be mild or severe, and babies with life-threatening defects need surgery right away [1].
What are the most common symptoms?
You may have no symptoms. When symptoms occur, they include shortness of breath, fatigue, chest pain, palpitations, dizziness or fainting, and swelling in the legs, ankles or feet [1].
How is the condition diagnosed?
Your provider listens to your heart for murmurs, clicks or snapping sounds, and echocardiography is the gold standard test. ECG, chest X-ray and cardiac catheterization may also be used [1].
What causes mitral valve stenosis?
Rheumatic fever is the most common cause, while calcium buildup with age can also cause mild or moderate stenosis [1].
Is mitral valve prolapse dangerous?
Mitral valve prolapse is often not significant, and not everyone with prolapse develops a significant leak. However, it seems more dangerous in men, who are more likely to have prolapse that leads to severe regurgitation [1].
Can medications cure the disease?
Medications such as diuretics, beta-blockers and calcium channel blockers ease symptoms, and blood thinners can lower the risk of clots. Repairing or replacing the valve is done through procedures or surgery [1].
When is surgery or a procedure needed?
Treatment depends on your symptoms, and you may not need any if you have none. If you do need it, your provider will discuss repair, replacement, or a minimally invasive or catheter-based option with you [1]. Trials of transcatheter repair in secondary mitral regurgitation have had mixed results, so selection of patients matters [2][3].
What are the complications of untreated mitral valve disease?
Severe damage to the mitral valve can harm your heart over time and lead to serious problems such as heart failure. Atrial fibrillation and heart failure can also affect your symptoms [1].
References
Cleveland Clinic. Mitral Valve Disease. Cleveland Clinic. June 4, 2022. https://my.clevelandclinic.org/health/diseases/23235-mitral-valve-disease
Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379(24):2307-2318. PMID 30280640. https://doi.org/10.1056/NEJMoa1806640
Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018;379(24):2297-2306. PMID 30145927. https://doi.org/10.1056/NEJMoa1805374
Watkins DA, Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990-2015. N Engl J Med. 2017;377(8):713-722. PMID 28834488. https://doi.org/10.1056/NEJMoa1603693
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The clinical information in this guide reflects source material last reviewed in June 2022.
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