Mitral regurgitation natural history: Difference between revisions
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Revision as of 21:57, 9 December 2011
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Mitral Regurgitation Microchapters |
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Mitral regurgitation natural history On the Web |
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Risk calculators and risk factors for Mitral regurgitation natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [3]
Overview
The pathophysiology of chronic mitral regurgitation can be divided into three phases; Acute mitral regurgitation, chronic compensated phase and chronic decompensated phase. This depends on the left ventricular (LV) chamber size and function. Knowing the stage of chronic mitral valve regurgitation enables the clinician to predict the LV function and expect the symptoms of the patient, so he or she can decide if the patient could get benefit from the surgical treatment. Usually, a corrective surgery for mitral valve regurgitation should be performed before the transition to the decompensated stage of the disease, because at this stage any treatment may provide symptomatic relief only, but ventricular enlargement and a low LVEF (Left ventricular ejection fraction) usually persist even with successful surgery.
How well a patient does depends on the cause and severity of the valve leakage. Milder forms may become a chronic condition. Abnormal heart rhythms associated with acute mitral regurgitation can sometimes be deadly.
Complications of Mitral Regurgitation
Mitral Regurgitation when mild almost never cause any complications. However, when severe, it may lead to development of:
- Pulmonary Edema.
- Pulmonary Hypertension.
- Right Heart Failure.
- Atrial Fibrillation.
- Thromboembolism-Stroke.
- Endocarditis.
Prognosis
- Patients with asymptomatic chronic severe mitral regurgitation have a high likelihood of developing symptoms or LV dysfunction over the course of 6 to 10 years [1] [2] [3]. However, the incidence of sudden death in asymptomatic patients with normal LV function varies widely among these studies.
- Clinical outcome is poor in patients with severe symptomatic mitral regurgitation with eight year survival rate of 33% without surgical intervention. Heart failure being the common cause with sudden death attributing to ventricular arrhythmia [4].
- In patients with severe mitral regurgitation due to a flail posterior mitral leaflet, 90% of patients are dead or require MV operation at 10 years with the mortality rate in patients with severe mitral regurgitation being 6% to 7% per year. However, the risk of death are predominantly in patients with a left ventricular ejection fraction <60% or with NYHA functional class III–IV symptoms [1] [5].
- Severe symptoms also predict a poor outcome after mitral valve repair or replacement. Postoperative survival rates in patients with NYHA functional class III–IV symptoms at 5 and 10 years are 73 ± 3% and 48 ± 4%, respectively. While in patients with NYHA functional class I/II symptoms before surgery survival rates at 5 and 10 years are 90 ± 2% and 76 ± 5%, respectively [5].
- In a long-term retrospective study [2], 198 patients with an effective orifice area >40 mm² had a risk of cardiac death at 4% per year during a mean follow-up period of 2.7 years. However, in the another study where 132 patients were followed up prospectively for 5 years, indications for surgery were development of symptoms, LV dysfunction (EF <60%), LV dilatation (LV end-systolic diameter >45 mm), atrial fibrillation, or pulmonary hypertension and there was only 1 cardiac death in an asymptomatic patient, but this patient had refused surgery though it was indicated by development of LV dilation [3]. This suggests good prognosis with valve surgery.
- In 80% of patients with atrial fibrillation greater than or equal to 3 months duration during the pre-operative period had persistence of atrial fibrillation after surgery. Hence, mitral valve repair should be done before or soon after the onset of atrial fibrillation to maximize the chance of postoperative sinus rhythm and avoid long-term anticoagulation with warfarin [6].
References
- ↑ 1.0 1.1 Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL (1996). "Clinical outcome of mitral regurgitation due to flail leaflet". The New England Journal of Medicine. 335 (19): 1417–23. doi:10.1056/NEJM199611073351902. PMID 8875918. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 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 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H (2006). "Outcome of watchful waiting in asymptomatic severe mitral regurgitation". Circulation. 113 (18): 2238–44. doi:10.1161/CIRCULATIONAHA.105.599175. PMID 16651470. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ Delahaye JP, Gare JP, Viguier E, Delahaye F, De Gevigney G, Milon H (1991). "Natural history of severe mitral regurgitation". European Heart Journal. 12 Suppl B: 5–9. PMID 1936025. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 Tribouilloy CM, Enriquez-Sarano M, Schaff HV, Orszulak TA, Bailey KR, Tajik AJ, Frye RL (1999). "Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications". Circulation. 99 (3): 400–5. PMID 9918527. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ Chua YL, Schaff HV, Orszulak TA, Morris JJ (1994). "Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty?". The Journal of Thoracic and Cardiovascular Surgery. 107 (2): 408–15. PMID 8302059. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help)