Mitral regurgitation

Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 3/4 of the population. Pathologic mitral regurgitation is a common hospital diagnosis, but the percent of patients with mitral valve disease who ever require surgical correction is very small. There are many etiologies of mitral regurgitation, caused by either pathologic changes to one or more of the components of the mitral valve, including the leaflets, annulus, chordae tendineae, papillary muscles, or by abnormalities of the surrounding left ventricle and/or atrium. Mitral regurgitation can be diagnosed on physical exam or by angiography, but is best diagnosed and quantified using echocardiography. The outcome of mitral regurgitation depends on the acuity of onset of the regurgitation, as well as etiology of the mitral valve disease. Acute mitral regurgitation requires urgent mitral valve surgery. In contrast, most patients with chronic mitral regurgitation will never need corrective surgery. Currently, there is not convincing evidence that medical therapy with vasodilating medications slows the progression of mitral regurgitation. When patients with chronic mitral regurgitation develop symptoms of pathologic changes to the left ventricle, surgical treatment should be offered. Mitral valve repair is the preferred corrective surgery, and only when not possible should mitral valve replacement be performed.