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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

  • S3
  • 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

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