Mitral regurgitation
Mitral regurgitation is systolic backflow from the left ventricle into the left atrium, classified as primary (valve disease) or secondary (ventricular or annular disease). Chronic disease causes volume overload with an apical holosystolic murmur, while acute severe regurgitation causes pulmonary edema; severe primary disease is treated with valve repair or replacement.
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What this article covers
- Overview
Definition: mitral regurgitation is systolic reflux of blood from the left ventricle into the left atrium, classified as primary (intrinsic valve disease) or secondary/functional (from ventricular or…
- Epidemiology
One of the most common valve lesions. Primary disease is often degenerative (mitral valve prolapse); secondary disease accompanies ischemic and dilated cardiomyopathy.
- Risk factors
Primary: mitral valve prolapse, rheumatic disease, endocarditis, and mitral annular calcification.
- Pathophysiology
Volume overload: regurgitant flow loads the left atrium and ventricle, causing eccentric hypertrophy and dilation.
- Clinical features
Chronic: exertional dyspnea, fatigue, and palpitations.
- Differential diagnosis
Aortic stenosis: a systolic murmur radiating to the carotids rather than the axilla, with a crescendo-decrescendo rather than holosystolic contour (Aortic stenosis).
- Diagnosis
Establish and grade with echocardiography assessing the jet, regurgitant volume and fraction, and ventricular size and function: the diagnostic basis is echocardiography defining the mechanism…
- Management
First-line, repair the valve in severe symptomatic primary disease: mitral valve repair (preferred over replacement) is indicated for severe primary regurgitation with symptoms, or with a reduced…
- Complications
Heart failure and pulmonary edema. Atrial fibrillation and cardioembolic stroke.
- Prognosis
Excellent after timely repair of primary disease.
- Prevention
Timely surgery in primary disease before irreversible dysfunction.
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Related articles
- Mitral valve prolapse
Mitral valve prolapse is systolic displacement of one or both mitral leaflets into the left atrium, usually from myxomatous degeneration, marked by a mid-systolic click and a late systolic murmur. Most cases are benign, but it is the leading cause of primary mitral regurgitation and a small subset carry arrhythmic risk. Management is reassurance for benign disease, beta-blockers for symptoms, and mitral valve repair for severe regurgitation.
- Mitral stenosis
Mitral stenosis is obstruction of left atrial emptying from a narrowed mitral valve, overwhelmingly rheumatic in origin. It causes left atrial hypertension, atrial fibrillation, and pulmonary congestion, with a diastolic rumble and opening snap; severe symptomatic disease is treated with percutaneous balloon valvuloplasty or valve surgery.
- Heart failure
Heart failure is a clinical syndrome of impaired cardiac filling or ejection causing congestion and reduced perfusion, classified by ejection fraction. Diagnosis integrates symptoms, signs, natriuretic peptides, and echocardiography, and treatment of reduced-ejection-fraction disease is quadruple guideline-directed therapy, with device therapy and cause-specific management.
- Aortic stenosis
Aortic stenosis is obstruction to left ventricular outflow from a narrowed aortic valve, most often calcific degeneration in older adults or a bicentric bicuspid valve earlier in life. Symptoms of angina, syncope, or heart failure mark a poor prognosis, and severe symptomatic disease is treated with valve replacement (surgical or transcatheter).
- Tricuspid regurgitation
Tricuspid regurgitation is systolic backflow from the right ventricle into the right atrium, most often secondary (functional) from right ventricular or annular dilation and pulmonary hypertension. It causes right-sided congestion with a prominent jugular v wave and a systolic murmur that increases on inspiration; management targets the underlying cause and, in selected severe disease, valve intervention.
- Ventricular septal defect
Ventricular septal defect is a hole in the interventricular septum causing a left-to-right shunt, the most common congenital heart defect. Small defects produce a loud murmur but close spontaneously, while large defects cause heart failure and pulmonary hypertension and require closure before irreversible pulmonary vascular disease (Eisenmenger physiology) develops.
- Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is an autosomal dominant sarcomere disease causing unexplained left ventricular hypertrophy, often with dynamic left ventricular outflow tract obstruction, and is a leading cause of sudden cardiac death in young people. Diagnosis is by echocardiography or cardiac MRI showing unexplained hypertrophy, and management includes negative inotropes, obstruction relief, and ICD placement for high sudden-death risk.
- Papillary muscle rupture
Papillary muscle rupture is a mechanical complication of myocardial infarction in which necrosis of a papillary muscle, usually the single-blood-supply posteromedial one, causes acute severe mitral regurgitation, flash pulmonary edema, and cardiogenic shock days after an infarct. Diagnosis is by urgent echocardiography, and treatment is afterload reduction and mechanical support as a bridge to emergent mitral valve surgery.