Mitral Regurgitation for Providers
Moderate or severe regurgitation is the most frequent valve disease in the United States, and affects more than 2 million people.
The main causes are:
- Degenerative (prolapse/flail)
- Ischemic (consequences of CAD or infarct)
- Rheumatic (developing countries)
- Functional (from LV dysfunction)
This disease progresses insidiously because the heart compensates for increasing regurgitant volume by left-atrial enlargement. It eventually causes left-ventricular overload and dysfunction. Mitral regurgitation yields poor outcome when it becomes severe.
Yearly mortality rates with medical therapy in patients aged 50 years or older are about three percent for moderate organic regurgitation and about six percent for severe organic regurgitation. Surgery is the only treatment proven to improve symptoms and prevent heart failure. Valve repair improves outcomes compared with valve replacement, and reduces mortality in severe organic mitral regurgitation by 70 percent. The best short- and long-term results are in asymptomatic patients operated on in advanced repair centers with low operative mortality (< one percent) and high repair rates (≥80–90 percent).
Initial clinical assessment of mitral regurgitation patients
Look for symptoms and signs of congestive heart failure.
Physical signs of severe mitral regurgitation
- Laterally displaced PMI indicates cardiac enlargement
- Murmur in systole: may be click/murmur, may be late systole, may be holosystolic or murmur may be absent
- Diastolic rumble from high diastolic flow, from large regurgitant volumes
Get an echocardiogram
- TransThoracic Echo (TTE): For left atrial size, left ventricular size and function, MR severity and possibly MR mechanism, pulmonary pressure, right ventricular size and function, End Systolic Dimension
- TransEsophageal Echo (TEE): In any patient in whom TTE is non-diagnostic for MR severity or LV function, and to delineate mechanism of MR and feasibility of repair.
Learn More Here
ACC/AHA Guidelines Severity Indicators
The Pathophysiological Triad - Etiology, Lesions and Dysfunction
Echocardiographic Prevalence of MR
MR Prevalence Increases with Age
A New Risk Factor
ACC/AHA MR Surgery Guidelines Flowchart
Earlier Mitral Valve Intervention Reduces Operative Mortality
What Happens If You Don't Operate?
What Happens If You Do Operate?
Evaluation Problems in Canada
Evaluation Problems in Europe
Guideline Adherence in USA
Life Expectancy in US Population