This presentation contains details of clinical features, diagnosis and management of mitral regurgitation.

1. MITRAL REGERGITATION
K. Kavindya M. Fernando
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2. Mitral regergitation
• Mitral valve
– Consist of fibrous annulus,
– Anterior & posterior leaflets
– Chordae tendinae,
– Papillary muscle
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3. Causes
• Can be due to abnormalities of the
– valve leaflets
– Annulus
– Chordae tendineae
– Papillary muscle of the left ventricle
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4. Causes
• Most common causes
– Degenerative (myxomatous) disease
– Ischemic heart disease
– Rheumatic heart disease
– Infectious endocarditis
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5. Causes
• MR also seen in diseases of the
myocardium (dialated and hypertrophic
cardiomyopathy),
• Rheumatic autoimmune diseases
• Eg: SLE
• Collagen diseases
• Eg: Marfan’s syndrome
• Ehlers –Danlos syndrome
• Drugs inducing centrally acting appetite
suppressants, and dopamine agonists
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6. Pathophysiology
• Due to regurgitation into L atrium
– L/ atrium dilates
– Little increase in left atrial pressure if the
regurgitation is long standing
• In acute MR
– L/ atriam does not dilate
– So pressure inside it increases
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7. Pathophysiology
• Thus in acute MR
– Left arterial v-wave is greatly increased
– Pulmonary venous pressure rises to produce
pulmonary edema
• Proportion of the stroke volume
regurgitate
• Stroke volume increases to maintain CO
• So Left ventricle enlarges
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8. Pathophysiology
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9. Pathophysiology
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10. Pathophysiology
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11. Symptoms
• Increased SV 
– symptoms of R/ heart failure
– Eventually leads to congestive cardiac failure
• Cardiac cachexia may developed
• Thromboembolism is less common
• Sub-acute infective endocarditis is much
more commoner
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12. Signs
• Pulse : sinus rhythm or atrial
fibrillation
• Apex: Forceful, displaced,
Systolic thrill
• Sounds : Soft S1, S3
• Murmurs: Pansystolic
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13. Signs
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14. Signs of uncomplicated MR
• Laterally displaced diffuse apex beat and a
systolic thrill
• Soft 1st heart sound
• Pansystolic murmur
– Loudest at apex
– Radiating widely over the precordium & into
the axilla
• With a floppy mitral valve : there may be a
mild systolic click
• Prominent 3rd heart
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15. Investigation
• Chest X-ray
• Electrocardiogram
• Echocardiogram
• Cardiac catheterization
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16. Investigation – X-ray
• Left atrial, Left ventricular
enlargement
• Increase in CTR, and valve calcification
is seen
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17. Investigation – ECG
• Features of
– left atrial delay (bifid P wave)
– Left ventricular hypertrophy
• Tall R waves in left lateral leads (I & V6)
• Deep S wave in R sided precordial area ( V1, V2)
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18. Investigation – ECG
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19. Investigation – Echocardiogram
• Dilate left atrium and left ventricle
• May be specific features of chordal or
papillary muscle rupture
• TOE can be done
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20. Treatment
• Prophylaxis against endocarditis
• Any evedence of progressive cardiac
enlargement  surgical
– Mitral valve repair
– Mitral valve replacement
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21. Prolapsing (Billowing) mitral valve
• Barlow’s syndrome/ floppy mitral valve
• Due to excessively large mitral valve
leaflets,enlarged mitral annulus
• More common in young females
• Cause is unknown but associate with
Marfan’s syndrome, thyrotoxicosis,
rheumatic or ischemic heart disease
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