Mitral Regurgitation

Mitral regurgitation — a leaking mitral valve — is the most common heart valve leak. The mitral valve sits between the heart's two left chambers; when it fails to close properly, blood flows backwards with every beat, forcing the heart to work harder and, over time, causing it to enlarge and weaken. Like other valve leaks, it can progress silently for years — and like other valve conditions, outcomes are best when treatment comes at the right time, before the heart muscle is damaged.

The mitral valve controls blood flow between the left atrium and the left ventricle — the heart's main pumping chamber. Its two leaflets are anchored by fine cords, like the ropes of a parachute. In mitral regurgitation, the leaflets no longer seal, and a portion of each heartbeat leaks backwards into the atrium and towards the lungs.

The consequences build gradually: the heart enlarges to handle the extra volume, pressure rises in the lungs, breathlessness develops, and the stretched atrium becomes prone to atrial fibrillation. Severity is graded as mild, moderate or severe on echocardiography — and mild leaks, which are extremely common, are often entirely innocent.

Understanding why the valve leaks matters as much as how much it leaks:

• Primary (degenerative) mitral regurgitation — the valve itself is the problem, most commonly mitral valve prolapse, where a floppy leaflet bulges backwards; cord rupture and previous infection are other causes
• Secondary (functional) mitral regurgitation — the valve is structurally normal but leaks because the heart around it has enlarged or weakened, usually from heart failure or previous heart attack

The distinction drives everything that follows: primary regurgitation is a valve problem treated by fixing the valve; secondary regurgitation is first and foremost a heart muscle problem, treated by optimising the heart — with valve intervention in carefully selected patients.

Mitral regurgitation is often silent for years. Symptoms, when they develop, include:

• Breathlessness on exertion — the most common first symptom, progressing to breathlessness lying flat or waking you at night
• Fatigue and declining exercise capacity
• Palpitations — often from atrial fibrillation, which frequently accompanies significant mitral regurgitation
• Ankle swelling in later stages

As with other valve leaks, symptoms are a late sign — the heart compensates quietly first. Many patients adapt without realising: slowing down, avoiding hills, blaming age. Regular imaging surveillance of a significant leak matters more than waiting to feel unwell.

Your first appointment lasts up to 30 minutes and includes:

1. A detailed symptom and exercise capacity assessment — including the gradual changes patients often discount
2. A review of previous echocardiograms — the trend in the leak and the heart's dimensions over time
3. A physical examination — mitral regurgitation produces a characteristic murmur
4. A resting ECG — also checking for atrial fibrillation, a common companion
5. A clear plan — grading the leak, establishing its mechanism, and setting a surveillance or treatment strategy

• Echocardiogram — the cornerstone test: grading the leak, identifying its mechanism (prolapse, cord rupture, ventricular enlargement) and measuring the heart's size and function
• Transoesophageal echocardiogram (TOE) — an ultrasound probe passed into the food pipe under sedation, giving exquisitely detailed views of the mitral valve; essential for planning repair or transcatheter treatment
• Cardiac MRI — precise quantification of the leak and heart volumes when echo findings are borderline
• Exercise testing — unmasking symptoms and assessing how the leak behaves under exertion, which can change management
• Ambulatory ECG monitoring — detecting atrial fibrillation
• Blood tests — including NT-proBNP, a marker of heart strain that supports timing decisions
• Coronary angiography — checking the heart's arteries before any intervention, performed by me personally

Most patients complete their assessment within one to two weeks.

Mild and moderate regurgitation requires monitoring rather than intervention — periodic echocardiograms, blood pressure control, and prompt reporting of new symptoms or palpitations.

Severe primary regurgitation is treated by fixing the valve, with intervention recommended when symptoms develop or when imaging shows the heart beginning to enlarge or weaken, or atrial fibrillation or raised lung pressures appear — even in patients who feel well. Options include:

• Surgical mitral valve repair — the gold standard for degenerative disease, particularly prolapse: the patient keeps their own valve, and in expert hands repair rates and long-term results are excellent. Timing referral to a high-volume repair surgeon is a key part of my role
• Surgical valve replacement — where repair is not feasible
• Transcatheter edge-to-edge repair (TEER, e.g. MitraClip) — a keyhole procedure in which the leaking leaflets are clipped together via a vein in the groin, without opening the chest. An established option for patients at high surgical risk with suitable anatomy — assessed in detail with a TOE

Severe secondary regurgitation is treated first by optimising the underlying heart condition — modern heart failure medication can substantially reduce the leak itself. Where significant regurgitation persists despite optimal treatment, transcatheter edge-to-edge repair improves symptoms and outcomes in appropriately selected patients.

Every case is discussed at a specialist Heart Team meeting of structural cardiologists and mitral surgeons, and I will explain the reasoning behind your recommendation openly — including, where relevant, why intervention is advised before symptoms take hold.

• Structural heart disease is my subspecialty — Consultant Interventional and Structural Cardiologist with expertise across valve assessment and transcatheter intervention
• Mechanism-focused assessment — establishing not just how severe the leak is, but why it exists — the distinction that determines the right treatment
• PhD from King's College London, structural intervention fellowship at San Raffaele Hospital, Milan, and over 100 peer-reviewed publications in valve and coronary disease
• The complete pathway under one consultant — from murmur assessment and grading through surveillance, Heart Team discussion and follow-up after intervention
• Rapid access — same-week appointments at Heart Health Welbeck London (Marylebone), Cromwell Hospital (Kensington), The Wellington Hospital (St John's Wood), Bupa Health Care Canary Wharf, The Essex Cardiothoracic Centre (Basildon)
• Consultations in English and Turkish
• Recognised by all major private medical insurers; self-paying patients welcome

A leaking mitral valve is best treated before the heart muscle is impacted — expert assessment establishes the right treatment, at the right time. Contact my practice team to arrange a consultation at one of my London or Essex locations.

Contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a consultation.