Mitral regurgitation (MR) may present with dyspnoea, usually on exertion, palpitations, and/or decreased exercise tolerance.
Typically presents as a holosystolic blowing murmur at the apex, radiating to axilla.
Transthoracic echo is the diagnostic test of choice in identifying presence, severity, and mechanism of MR.
Colour Doppler flow and continuous-wave Doppler studies can assess severity of regurgitation, left ventricular dimensions, size and function of the right ventricle, and pulmonary artery systolic pressure.
Surgical treatment is the best available treatment option, although percutaneous approaches have gained significant potential.
The most common complications of surgical treatment are failure of repair, prosthetic valve stenosis, endocarditis, and mitral valve patient-prosthesis mismatch.
The mitral valve apparatus consists of anterior and posterior leaflets, chordae tendineae, anterolateral and posteromedial papillary muscles, and mitral annulus. Any aberrations of the mitral valve apparatus, due to mechanical, traumatic, infectious, degenerative, congenital, or metabolic causes, may lead to mitral regurgitation (MR).
Mild to moderate disease can be asymptomatic for many years; however, with progression of the disease, eccentric cardiac hypertrophy occurs, which leads to elongation of the myocardial fibres and increased left ventricular end-diastolic volume. Eventually, prolonged volume overload leads to left ventricular dysfunction and increased left ventricular end-systolic diameter.
History and exam
Prakash P. Punjabi, FRCS, FESC, MS, MCh
Consultant Cardiothoracic Surgeon
National Heart and Lung Institute
Imperial College Faculty of Medicine
Imperial College Healthcare NHS Trust - Hammersmith Hospital
PPP is an author of references cited in this monograph. PPP declares that he has no competing interests.
Dr Prakash P. Punjabi would like to gratefully acknowledge Dr Samir Kapadia and Dr Mehdi H. Shishehbor, previous contributors to this monograph. SK and MHS declare that they have no competing interests.
Leonardo Rodriguez, MD
Cardiovascular Imaging Center
Department of Cardiology
Cleveland Clinic Foundation
LR declares that he has no competing interests.
Ruth Falik, MD
Associate Professor of Medicine
Department of Medicine
Baylor College of Medicine
RF declares that she has no competing interests.
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