Internal Diseases and Therapy · MU Sofia

14. Diseases of the mitral valve: mitral regurgitation

Covers mitral regurgitation, from its definition and the primary versus secondary division that guides treatment, through causes, haemodynamics of chronic and acute forms, and the Carpentier and echocardiographic severity classifications. It then describes symptoms and signs, mitral valve prolapse, diagnostic tests including the PISA method, differential diagnosis, treatment indications and options, complications and prognosis.

Inside: 10 sections · 3 labelled pictures · 3 tables · 16 flashcards · 14 min

Topic 14 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 10 sections, about 1,853 words (14 min of reading), with 16 flashcards.

In this note

  1. Definition
  2. Etiology
  3. Pathophysiology and haemodynamics
  4. Classification
  5. Clinical features
  6. Diagnosis
  7. Differential diagnosis
  8. Treatment
  9. Complications
  10. Prognosis

Definition

Mitral regurgitation (MR) is the systolic backflow of blood from the left ventricle (LV) into the left atrium (LA), because the mitral leaflets fail to close (coapt) completely.

  • Closure needs every part of the mitral apparatus: the annulus, the anterior and posterior leaflets, the chordae tendineae, the papillary muscles and the LV wall beneath them. A fault in any part can cause MR.
  • A trace of MR is a normal finding on echocardiography. Significant MR is the second most common valve disease needing intervention in Europe, after aortic stenosis.

Image: “Blausen 0645 MitralValve RegurgitationvsStenosis” by BruceBlaus . When using this image in external sources it can be cited as: Blausen.com staff (2014). " Medical gallery o, CC BY 3.0, via Wikimedia Commons.

Etiology

The key division, which decides treatment, is between disease of the valve itself (primary) and disease of the ventricle or atrium with a normal valve (secondary).

Primary (organic, degenerative) MR

  • Mitral valve prolapse (MVP) from myxomatous degeneration is the most common cause in Europe: diffuse excess tissue in younger patients (Barlow disease) or thin leaflets with chordal rupture in older patients (fibroelastic deficiency). MVP affects 2–3% of the population; it is associated with Marfan and Ehlers–Danlos syndromes, osteogenesis imperfecta and adult polycystic kidney disease.
  • Rheumatic heart disease: the most common cause worldwide in young people; often combined with mitral stenosis.
  • Infective endocarditis: leaflet perforation, destruction or chordal rupture.
  • Papillary muscle rupture in acute myocardial infarction, usually the posteromedial muscle (single blood supply, inferior infarction).
  • Others: congenital cleft of the anterior leaflet (atrioventricular septal defect), systemic lupus erythematosus (Libman–Sacks), drugs (ergot derivatives, cabergoline, pergolide, fenfluramine, benfluorex), radiotherapy, trauma, heavy annular calcification.

Secondary (functional) MR

  • Ventricular: LV dilatation and dysfunction in ischaemic or dilated cardiomyopathy displaces the papillary muscles → the leaflets are pulled into the ventricle (tethering) and cannot meet; the closing force is also reduced.
  • Atrial: long-standing atrial fibrillation (AF) or heart failure with preserved ejection fraction dilates the LA and the annulus.
  • Hypertrophic obstructive cardiomyopathy: systolic anterior motion of the anterior leaflet.

Continue reading free

The whole note, all 10 sections, is free with an AceMed account, with its 16 flashcards. Premium adds flashcard recall, highlights and Ask AI.

Start freeAlready a member? Open the note