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mitral regurgitation (MR)

Classification: 1) acute mitral regurgitation 2) chronic mitral regurgitation Clinical manifestations: - holosystolic murmur Pathology: - abnormal systolic back flow of blood from the left ventricle into the left atrium, resulting from imperfect closure of the mitral valve Special laboratory: - transthoracic echocardiagram a) regurgitant oriface area b) regurgitant volume c) regurgitant fraction d) transesophageal echocardiogram (TEE) if transthoracic echocardiogram (TTE) inadequate [3,6] - repeat echocardiography indicated when there is a change in clinical status (even if most recent echocardiogram was 3-4 months prior) [3] Complications: - atrial fibrillation* associated with long-term mortality in patients with degenerative mitral regurgitation [9] * paroxysmal atrial fibrillation or persistent atrial fibrillation Management: - see acute mitral regurgitation &/or chronic mitral regurgitation - consensus decision pathway [7] - percutaneous repair of severe mitral regurgitation due to reduced LVEF with MitraClip device of no benefit [8] - transcatheter mitral valve repair with 5-year advantage over medical care for patients with moderate-severe mitral regurgitation [10] - surgery improves survival in patients with atrial fibrillation [9]

Related

heart murmur mitral valve mitral valve prolapse (MVP) mitral valve repair

Specific

acute mitral regurgitation (MR) chronic mitral regurgitation (MR)

General

mitral valve disease

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 128-29
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 44
  3. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2022
  4. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  5. Foster E. Clinical practice. Mitral regurgitation due to degenerative mitral-valve disease. N Engl J Med. 2010 Jul 8;363(2):156-65 PMID: 20647211
  6. Solis J, Piro V, Vazquez de Prada JA, Loughlin G Echocardiographic assessment of mitral regurgitation: general considerations. Cardiol Clin. 2013 May;31(2):165-8. PMID: 23743069
  7. O'Gara PT, Grayburn PA, Badhwar V et al 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation. A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. Oct 2017 PMID: 29055505 http://www.onlinejacc.org/content/early/2017/10/16/j.jacc.2017.09.019
  8. Obadia JF, Messika-Zeitoun D, Leurent G et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 2018 Aug 27 PMID: 30145927 Free full text https://www.nejm.org/doi/10.1056/NEJMoa1805374
  9. Grigioni F, Benfari G, Vanoverschelde JL et al. Long-term implications of atrial fibrillation in patients with degenerative mitral regurgitation. J Am Coll Cardiol 2019 Jan 29; 73:264-274 PMID: 30678755 https://www.sciencedirect.com/science/article/pii/S0735109718392131
  10. Stone GW et al. Five-year follow-up after transcatheter repair of secondary mitral regurgitation. N Engl J Med 2023 Mar 5; [e-pub] PMID: 36876756 https://www.nejm.org/doi/10.1056/NEJMoa2300213