Chronic mitral regurgitation treatment: Difference between revisions
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Vasodilator therapy is a mainstay in the management of chronic mitral regurgitation. In the chronic state, the most commonly used agents are [[ACE inhibitor]]s and [[hydralazine]]. Studies have shown that the use of ACE inhibitors and hydralazine can delay surgical treatment of mitral regurgitation<ref name="pmid668075">{{cite journal |author=Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K |title=Beneficial effects of hydralazine in severe mitral regurgitation |journal=[[Circulation]] |volume=58 |issue=2 |pages=273–9 |year=1978 |month=August |pmid=668075 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=668075 |accessdate=2011-03-16}}</ref> <ref name="pmid10149580">{{cite journal |author=Hoit BD |title=Medical treatment of valvular heart disease |journal=[[Current Opinion in Cardiology]] |volume=6 |issue=2 |pages=207–11 |year=1991 |month=April |pmid=10149580 |doi= |url= |accessdate=2011-03-16}}</ref>. The current guidelines for treatment of mitral regurgitation limit the use of vasodilators to individuals with [[hypertension]] | |||
There are two surgical options for the treatment of mitral regurgitation: [[mitral valve replacement]] and [[mitral valve repair]] | There are two surgical options for the treatment of mitral regurgitation: [[mitral valve replacement]] and [[mitral valve repair]] | ||
Revision as of 19:18, 18 March 2011
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Vasodilator therapy is a mainstay in the management of chronic mitral regurgitation. In the chronic state, the most commonly used agents are ACE inhibitors and hydralazine. Studies have shown that the use of ACE inhibitors and hydralazine can delay surgical treatment of mitral regurgitation[1] [2]. The current guidelines for treatment of mitral regurgitation limit the use of vasodilators to individuals with hypertension
There are two surgical options for the treatment of mitral regurgitation: mitral valve replacement and mitral valve repair
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ACC/AHA guidelines for management of Chronic severe Mitral Regurgitation:Class I1. MV surgery is recommended for the following patients: A. Symptomatic patients with acute severe MR. (Level of Evidence: B) B. Patients with chronic severe MR and NYHA functional class II, III, or IV symptoms in the absence of severe LV dysfunction (severe LV dysfunction is defined as EF less than 0.30 and/ or end-systolic dimension greater than 55 mm). (Level of Evidence: B) C. Asymptomatic patients with chronic severe MR and mild to moderate LV dysfunction, EF 0.30 to 0.60, and/or end-systolic dimension greater than or equal to 40 mm. (Level of Evidence: B) 2. MV repair is recommended over MV replacement (MVR) in the majority of patients with severe chronic MR who require surgery, and patients should be referred to surgical centers experienced in MV repair. (Level of Evidence: C) Class IIa1. MV repair is reasonable in experienced surgical centers for asymptomatic patients with chronic severe MR with preserved LV function (EF greater than 0.60 and end-systolic dimension less than 40 mm) in whom the likelihood of successful repair without residual MR is greater than 90%. (Level of Evidence: B) 2. MV surgery is reasonable for the following patients: A. Asymptomatic patients with chronic severe MR, preserved LV function, and (1) new onset of atrial fibrillation or (2) pulmonary hypertension (pulmonary artery systolic pressure greater than 50 mm Hg at rest or greater than 60 mm Hg with exercise). (Level of Evidence: C) B. Patients with chronic severe MR due to a primary abnormality of the mitral apparatus, NYHA functional class III-IV symptoms, and severe LV dysfunction (EF less than 0.30 and/ or end-systolic dimension greater than 55 mm) in whom MV repair is highly likely. (Level of Evidence: C) Class IIb1. MV repair may be considered for patients with chronic severe secondary MR due to severe LV dysfunction (EF less than 0.30) who have persistent NYHA functional class III-IV symptoms despite optimal therapy for heart failure, including biventricular pacing. (Level of Evidence: C) Class III1. MV surgery is not indicated for asymptomatic patients with MR and preserved LV function (EF greater than 0.60 and end-systolic dimension less than 40 mm) in whom significant doubt about the feasibility of repair exists. (Level of Evidence: C) 2. Isolated MV surgery is not indicated for patients with mild or moderate MR. (Level of Evidence: C) |
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References
- ↑ Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K (1978). "Beneficial effects of hydralazine in severe mitral regurgitation". Circulation. 58 (2): 273–9. PMID 668075. Retrieved 2011-03-16. Unknown parameter
|month=ignored (help) - ↑ Hoit BD (1991). "Medical treatment of valvular heart disease". Current Opinion in Cardiology. 6 (2): 207–11. PMID 10149580. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help)