Your Patient Has Mitral Regurgitation – Now What?
This infographic provides a structured guide for evaluating mitral regurgitation (MR) found on echocardiography. It breaks down the etiology, classification, and severity of MR, helping guide management decisions.
Is it Primary or Secondary MR?
- Primary (Degenerative) MR:
- Caused by abnormalities of the leaflets, chordae tendineae, or papillary muscles.
- Common causes include:
- Fibroelastic deficiency and myxomatous degeneration
- Rheumatic heart disease
- Radiation-induced valve disease
- Infective endocarditis affecting leaflet integrity
- Secondary (Functional) MR:
- Results from ventricular remodeling or annular dilation affecting valve function.
- Causes include:
- Nonischemic cardiomyopathy (NICM) with LV dilation
- Ischemic cardiomyopathy (ICM) causing posterior leaflet tethering
- Atrial functional MR related to annular dilation from chronic atrial fibrillation
Carpentier’s Classification of MR
This classification provides further insights into leaflet motion abnormalities and helps guide treatment:
| Type | Motion Characteristic |
|---|---|
| I | Normal leaflet motion |
| II | Excess leaflet motion (e.g., in MVP) |
| IIIa | Restricted leaflet motion in both diastole and systole |
| IIIb | Restricted leaflet motion only during systole |
Assessing MR Severity
The ]MR severity stage
- Stage A: At risk
- Stage B: Progressive MR
- Stage C: Asymptomatic severe MR (C1: Normal LV function, C2: LV dysfunction)
- Stage D: Symptomatic severe MR
Severity is evaluated using echocardiographic parameters, including:
- Vena contracta width
- Regurgitant volume and fraction
- Effective regurgitant orifice area (EROA)
Treatment Options
- Mitral valve repair is generally preferred when feasible.
- Surgical replacement is recommended for symptomatic severe primary MR (Stage C2 or D).
- For secondary MR, transcatheter edge-to-edge repair (TEER) may be considered, particularly in patients with poor surgical candidates.
Produced by Dr. Haani Kamil
Edited by Dr. Sukriti Banthiya and Dr. Gurleen Kaur
Reviewed by Dr. Maggie Claaig and Dr. Ahmed Ghoneem
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