Mitral Regurgitation

Yongkasem Vorasettakarnkij, MD, MSc Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Disorder of mitral valve (MV) closure, either primary or secondary (functional), resulting in a backflow of the left ventricular (LV) stroke volume into the left atrium (LA); uncompe...

DIAGNOSIS

HISTORY

  • Associated conditions: RHD, prior MI, connective tissue disorder

  • Acute MR

    • Sudden onset of dyspnea

    • Orthopnea, paroxysmal nocturnal dyspnea

  • Chronic MR

    • Exertional dyspnea, fatigue

    • Palpitat...

TREATMENT

MEDICATION

  • Acute, severe MR

    • Medical therapy has a limited role and is aimed to stabilize hemodynamics preoperatively.

    • Vasodilators (nitroprusside, nicardipine): to improve hemodynamic compens...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Chronic MR: asymptomatic 
  • Mild MR with normal LV size and function and no pulmonary hypertension: annual clinical evaluation and TTE every 3 to 5 years

  • Moderate MR:...

REFERENCES

1 Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet.  2009;373(9672):1382–1394.  [View Abstract]
2 Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline ...

ADDITIONAL READING

  • Acker MA, Parides MK, Perrault LP, et al; for Cardiothoracic Surgical Trials Network. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. ...

CODES

ICD10

  • I34.0 Nonrheumatic mitral (valve) insufficiency

  • I05.1 Rheumatic mitral insufficiency

  • Q23.3 Congenital mitral insufficiency

ICD9

  • 424.0 Mitral valve disorders

  • 394.1 Rheumatic mitral insufficiency

  • 7...

CLINICAL PEARLS

  • Follow-up for mild to moderate MR: serial exam and/or echo unless LV structural changes

  • Severe MR is usually managed with MV repair.

  • Endocarditis prophylaxis is not recommended.

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