Mitral Valve Regurgitation

Click here for a full review of mitral regurgitation. Below is a brief summary.

Mitral regurgitation is the abnormal backward flow of blood from the left ventricle (LV) to the left atrium (LA) due to disease of the mitral valve apparatus (primary MR) or due to dilation of the MV annulus from LA or LV disease (secondary MR). In chronic MR, the LV can adapt quite well and symptoms may be delayed for years. However, in acute MR, the LV is unable to adequately compensate and symptoms are always present and are usually severe.

Indications for surgery include:

1. Symptoms related to heart failure that can be attributed to the mitral regurgitation and left ventricular ejection fraction > 30% (Class I)
2. Symptoms related to heart failure that can be attributed to the mitral regurgitation and left ventricular ejection fraction < 30%. Mitral repair not replacement likely. (Class IIa)
3. Asymptomatic severe mitral regurgitation if the left ventricular ejection fraction is < 60% and/or the end systolic dimension is > 40 mm. (Class I).
4. Asymptomatic severe mitral regurgitation with the left ventricular ejection fraction > 60% and end systolic dimension < 40 mm if atrial fibrillation or pulmonary hypertension is present (Class IIa).
5. Severe mitral valve regurgitation (usually from mitral valve prolapse) if repair rather than replacement is likely, even in the lack of symptoms and normal left ventricular ejection fraction (Class IIa).