Congestive heart failure and mitral regurgitation: Difference between revisions
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{{Congestive heart failure}} | {{Congestive heart failure}} | ||
'''Editor(s)-In-Chief:''' James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [mailto: | '''Editor(s)-In-Chief:''' James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School | ||
==Overview== | |||
==Indications for [[MVr/R]]== | ==Indications for [[MVr/R]]== | ||
1. [[Mitral regurgitation]] of 3+ or 4+ | 1. [[Mitral regurgitation]] of 3+ or 4+ | ||
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6. The left ventricular end-systolic dimension is ≥ 40mm | 6. The left ventricular end-systolic dimension is ≥ 40mm | ||
===Background=== | |||
*[[Mitral regurgitation]] is highly associated with [[systolic heart failure]] as a cause, sequela, or complication.<ref name="pmid15745978">{{cite journal |author=Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ |title=Quantitative determinants of the outcome of asymptomatic mitral regurgitation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=9 |pages=875–83 |year=2005 |month=March |pmid=15745978 |doi=10.1056/NEJMoa041451 |url=http://dx.doi.org/10.1056/NEJMoa041451 |accessdate=2012-04-03}}</ref> It confers independently and significantly increased mortality, regardless of its etiology or of the symptom status of the patient. Medical therapy has no significant impact on mortality associated with moderate to severe [[mitral regurgitation]]. | |||
*Corrective intervention consists of [[mitral valve replacement]] ([[MVR]]) and [[mitral valve repair]] (MVr). Adhering to AHA guidelines for the timing of corrective intervention in patients with 3+/4+ mitral regurgitation is highly effective at improving or, in the subset of asymptomatic patients with normal left ventricular function, normalizing longevity. | |||
*[[Mitral valve repair]], when technically practicable, is associated with a superior hemodynamic and physiological result, with lower risk of hemorrhagic, thromboembolic, and infectious complications when compared with [[mitral valve replacement]].<ref name="pmid21463154">{{cite journal |author=Feldman T, Foster E, Glower DD, Glower DG, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV, Massaro JM, Mauri L |title=Percutaneous repair or surgery for mitral regurgitation |journal=[[The New England Journal of Medicine]] |volume=364 |issue=15 |pages=1395–406 |year=2011 |month=April |pmid=21463154 |doi=10.1056/NEJMoa1009355 |url=http://dx.doi.org/10.1056/NEJMoa1009355 |accessdate=2012-04-03}}</ref> | |||
==References== | |||
{{Reflist|2}} | |||
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Latest revision as of 14:45, 1 November 2012
Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School
Overview
Indications for MVr/R
1. Mitral regurgitation of 3+ or 4+
and any of the conditions below:
2. History of prior heart failure or congestive heart failure
or
3. Tricuspid regurgitation gradient ≥ 30 mmHg
or
4. History of prior atrial fibrillation
or
5. The left ventricular ejection fraction (LVEF) is ≤ 60%
or
6. The left ventricular end-systolic dimension is ≥ 40mm
Background
- Mitral regurgitation is highly associated with systolic heart failure as a cause, sequela, or complication.[1] It confers independently and significantly increased mortality, regardless of its etiology or of the symptom status of the patient. Medical therapy has no significant impact on mortality associated with moderate to severe mitral regurgitation.
- Corrective intervention consists of mitral valve replacement (MVR) and mitral valve repair (MVr). Adhering to AHA guidelines for the timing of corrective intervention in patients with 3+/4+ mitral regurgitation is highly effective at improving or, in the subset of asymptomatic patients with normal left ventricular function, normalizing longevity.
- Mitral valve repair, when technically practicable, is associated with a superior hemodynamic and physiological result, with lower risk of hemorrhagic, thromboembolic, and infectious complications when compared with mitral valve replacement.[2]
References
- ↑ Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ (2005). "Quantitative determinants of the outcome of asymptomatic mitral regurgitation". The New England Journal of Medicine. 352 (9): 875–83. doi:10.1056/NEJMoa041451. PMID 15745978. Retrieved 2012-04-03. Unknown parameter
|month=
ignored (help) - ↑ Feldman T, Foster E, Glower DD, Glower DG, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV, Massaro JM, Mauri L (2011). "Percutaneous repair or surgery for mitral regurgitation". The New England Journal of Medicine. 364 (15): 1395–406. doi:10.1056/NEJMoa1009355. PMID 21463154. Retrieved 2012-04-03. Unknown parameter
|month=
ignored (help)