Management-oriented classification of mitral valve regurgitation.

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Diagnostics

Background:

• Traditional mitral regurgitation (MR) classifications focus on etiology or mechanism.
• Current MR management relies on severity, left ventricular (LV) function, and symptoms, necessitating a management-oriented classification.

Purpose of the Study:

• To introduce a novel, management-oriented classification system for mitral regurgitation (MR).
• To stratify MR based on left ventricular (LV) function and severity for improved clinical guidance.

Main Methods:

• Proposed a four-phase classification based on LV function: normal LV, normal ejection fraction (EF) with indirect dysfunction signs, reduced EF/mild-moderate LV dilatation, and severe LV dysfunction/dilatation.
• Subdivided each phase into three stages (A, B, C) based on effective regurgitant orifice (ERO) size (<20 mm, 20-39 mm, ≥40 mm).

Main Results:

• Phase I: Normal LV.
• Phase II: Normal EF with pulmonary hypertension/atrial fibrillation.
• Phase III: EF 30-49% and/or mild-moderate LV dilatation (40-54 mm).
• Phase IV: EF <30% and/or severe LV dilatation (≥55 mm).
• Stages A, B, C defined by ERO <20 mm, 20-39 mm, and ≥40 mm, respectively.

Conclusions:

• The proposed classification provides a structured framework for assessing MR severity and LV status.
• This system aims to guide evidence-based interventions and predict outcomes for patients with mitral regurgitation.