Mitral regurgitation.
Mitral regurgitation affects more than 2 million people in the USA. The main causes are classified as degenerative (with valve prolapse) and ischaemic (ie, due to consequences of coronary disease) in developed countries, or rheumatic (in developing countries). This disorder generally progresses insidiously, because the heart compensates for increasing regurgitant volume by left-atrial enlargement, causes left-ventricular overload and dysfunction, and yields poor outcome when it becomes severe. Doppler-echocardiographic methods can be used to quantify the severity of mitral regurgitation. Yearly mortality rates with medical treatment in patients aged 50 years or older are about 3% for moderate organic regurgitation and about 6% for severe organic regurgitation. Surgery is the only treatment proven to improve symptoms and prevent heart failure. Valve repair improves outcome compared with valve replacement and reduces mortality of patient with severe organic mitral regurgitation by about 70%. The best short-term and long-term results are obtained in asymptomatic patients operated on in advanced repair centres with low operative mortality (<1%) and high repair rates (>/=80-90%). These results emphasise the importance of early detection and assessment of mitral regurgitation.
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Maurice
M
Enriquez-Sarano
Cary W
CW
Akins
Alec
A
Vahanian
D015984:Causality; D019049:Developed Countries; D003906:Developing Countries; D018450:Disease Progression; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005080:Exercise Test; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008945:Mitral Valve Prolapse / Q000150:complications; D017202:Myocardial Ischemia / Q000150:complications; D017410:Practice Guidelines as Topic; D012214:Rheumatic Heart Disease / Q000150:complications; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology