What Are the Stages of Mitral Valve Regurgitation?

Physicians divide the regurgitation of the mitral valve into four stages that progress. Although symptoms usually don't show up until the end, early detection and intervention can help halt the disease's course.

The condition known as mitral regurgitation, also known as mitral valve regurgitation, occurs when the mitral valve malfunctions and blood escapes the heart out the back. On the left side of your heart, in the space between the two chambers, is the mitral valve.

According to guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC), mitral regurgitation is categorized into four stages, A through D, based on how severe the symptoms and signs are. The least severe stage is A, while the most severe stage is D.

Let's take a closer look at each stage of mitral valve regurgitation.

Mitral valve and heart anatomy

There are two upper chambers called atria (plural: atrium) and two lower chambers called ventricles that make up your heart.

Your left atrium and left ventricle are where you'll find your mitral valve. It consists of multiple structures that are susceptible to damage, such as:

• Leaflets: two opening and closing mechanisms that allow blood to pass through
• Mitral annulus: a fibrous ring serving as the location of leaflet insertion
• Chordae tendineae (chords): strands of fibre that pull the leaflets open
• Papillary muscles: Your leaflets open by pulling on the chordae tendineae muscles.

Stage A mitral regurgitation: At risk.

Mitral regurgitation in stage A is the mildest type. This stage puts a person at risk for mitral regurgitation.

Individuals at stage A possess:

• no symptoms
• no associated anatomical alterations brought on by variations in blood flow in their heart

• typical cords, annulus, and leaflets when cardiomyopathy or coronary artery disease is present

• minimal mitral regurgitation 

Treatment

For Stage A mitral regurgitation, you probably won't require therapy. Nevertheless, a physician could wish to routinely check on you and suggest lifestyle modifications to enhance your general heart health, like:

• reducing sodium intake
• reducing weight if you're obese or overweight
• limiting alcohol
• quitting or avoiding smoking

Stage B mitral regurgitation: Progressive

In terms of severity, the second stage is progressive mitral regurgitation. This stage is characterized by a greater degree of blood volume going backwards into the left atrium in individuals who do not yet exhibit symptoms.

Individuals in stage B may have:

• mild left atrial enlargement
• mild mitral regurgitation
• no expansion of the left ventricle or alteration of the blood arteries that supply the lungs

• mild to severe prolapse of the mitral valve, which causes the valve to buckle inward into the left atrium

• moderate constriction of the leaflets of the mitral valve and enlargement of the mitral annulus 

Treatment

Treatment for stage B mitral regurgitation is typically not necessary. Similar to stage A, your doctor might advise regular cardiac monitoring and suggest modifying your way of life.

Stage C mitral regurgitation: Asymptomatic severe

In addition to not causing symptoms, stage C mitral regurgitation also results in severe mitral regurgitation. Individuals at this point could have:

• severe mitral valve prolapse
• severe mitral regurgitation
• left ventricle enlargement
• thickness of the leaflets, potentially brought on by radiation treatment to the chest or an illness

• inflammation of the valves with leaflet restriction

• Mild to severe swelling of the left atrium

• pulmonary hypertension during activity or at rest 

Based on the extent of the left ventricle's alteration, doctors can separate patients in stage C into stages C1 and C2.

Treatment

According to ACC/AHA guidelines, patients with stage C2 illness should have surgery. The mitral valve is either replaced or repaired during these procedures.

When it is feasible, experts advise mitral valve repair over replacement.

Stage D mitral regurgitation: Symptomatic severe

Individuals in stage D have characteristics with those in stage C, but their symptoms and intensity are more severe. The following symptoms could be present in someone with stage D mitral regurgitation:

• fatigue
• a reduced exercise capacity
• breathlessness during rest or activity
• heart palpitations
• chest pain
• swelling in their
  • legs
  • abdomen
  • neck veins

Treatment

For patients with stage D mitral valve regurgitation, experts advise mitral valve surgery. Individuals who are highly susceptible to surgical problems may benefit from transcatheter edge-to-edge repair.

How do doctors determine the mitral regurgitation stage?

Your mitral regurgitation stage is determined by a range of tests performed by doctors. These may consist of:

• a physical exam
• a review of your symptoms
• angiography
• electrocardiography (ECG)
• echocardiogram

What is the life expectancy with mitral regurgitation by stage?

Mild mitral regurgitation may not shorten your life or cause any issues.

In a 2018 study, researchers observed that individuals who underwent mitral valve surgery had survival rates similar to those in the general population, based on 83 participants with an average age of 57 and no symptoms. In the study, there was no early death rate.

In general, experts believe that mitral valve repair is more survivable than mitral valve replacement.

Takeaway

Mitral valve regurgitation is classified by doctors into four phases, A through D. Usually, symptoms don't show up until stage D.

If your mitral valve regurgitation is in stage C2 or stage D, your doctor is likely to suggest surgery. Studies show that replacing the mitral valve is not as beneficial to survival as repairing it.

It's critical to follow up with a physician frequently if you are diagnosed with mitral valve regurgitation to determine whether your condition is becoming worse.