Mitral regurgitation means that the mitral valve does not close effectively and blood leaks backward into the left atrium. Treatment depends on whether the problem is primary disease of the valve itself or secondary regurgitation related to ventricular or atrial disease, as well as severity, symptoms, ventricular function, anatomy and procedural risk. A Heart Team should decide whether medical treatment, surgical repair or replacement, TEER or another approach is appropriate rather than selecting a procedure from the valve-leak diagnosis alone.
Primary and secondary mitral regurgitation are different clinical problems
Current European guidance separates primary mitral regurgitation, where the valve apparatus itself is diseased, from secondary mitral regurgitation caused by changes in the ventricle or atrium. The mechanism matters because it changes the treatment sequence and the expected role of surgery, heart-failure therapy and TEER.
Echocardiography defines severity and mechanism
A useful specialist review needs more than the phrase 'mitral insufficiency'. Transthoracic echocardiography is central, and transesophageal echocardiography or other imaging may be required to understand leaflet anatomy, regurgitation mechanism, ventricular function and suitability for repair or catheter treatment.
- Recent transthoracic echocardiography
- Transesophageal echocardiography when already performed
- Left-ventricular size and function
- Pulmonary pressures and right-heart findings
- Atrial fibrillation and other valve disease
- Prior cardiac surgery or intervention
Surgical repair is different from valve replacement
For suitable primary mitral regurgitation, specialist centers may be able to reconstruct the native valve. If reliable repair is not feasible, replacement with a prosthetic valve may be required. The surgical plan depends on valve anatomy, associated heart disease and the likelihood of durable repair.
TEER / MitraClip is a selected catheter-based pathway
Transcatheter edge-to-edge repair uses a catheter-delivered clip system to reduce regurgitation without open-heart surgery. Current guidelines support TEER in defined primary or secondary mitral-regurgitation scenarios when clinical and anatomical criteria are met. It should not be presented as a universal less-invasive substitute for surgical repair.
Records for an international Heart Team review
Send the records that allow the center to compare the available treatment strategies before travel.
- Echocardiography reports and images
- TEE images when available
- ECG and rhythm-monitoring reports
- Cardiac CT, MRI or coronary assessment if performed
- Heart-failure history and medication
- Previous valve or cardiac surgery reports
- Current functional limitations and major comorbidities
Sources and review
This guide was last source-reviewed on 2026-08-31.
- 2025 ESC/EACTS Guidelines for the management of valvular heart disease — European Society of Cardiology ↗
- Mitral valve treatment – surgery, repair and MitraClip — Deutsches Herzzentrum der Charité ↗
- Structural heart disease – mitral regurgitation and MitraClip — University Medical Center Hamburg-Eppendorf (UKE) ↗