Abstract
The clinical manifestations of mitral regurgitation (MR) are conditioned by the magnitude and rapidity of onset and the ability of the chambers of the heart to adapt from a hemodynamic and neuroendocrine perspective. Patients with MR are often asymptomatic despite a severe degree of valve regurgitation. The major symptom is dyspnea, at first on exertion and then at rest, accompanied by peripheral edemas, marked asthenia, and palpitations. The most serious clinical manifestation is acute pulmonary edema [1].
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Woolley K, Stark P. Pulmonary parenchymal manifestations of mitral valve disease. Radiographics. 1999;19(4):965–72.
Rahimtoola SH, Dell’Italia LJ. Mitral valve disease. In: Fuster V, Alexander RW, O’Rourke RA, et al., editors. Hurst’s the heart. 11th ed. New York: McGraw-Hill; 2004. p. 1669–95.
American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease), Society of Cardiovascular Anesthesiologists, Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48:1–148.
Vahanian A, Baumgartner H, Bax J, et al. Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–68.
Bonow RO, Carabello BA, Chatterjee K, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:523–661.
Zoghbi WA, Eriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.
Bargiggia GS, Tronconi L, Sahn DJ, et al. A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice. Circulation. 1991;84:1481–9.
Simpson IA, Shiota T, Gharib M, et al. Current status of flow convergence for clinical applications: is it a leaning tower of “PISA”? J Am Coll Cardiol. 1996;27:504–9.
Baumgartner H, Schima H, Kuhn P. Value and limitations of proximal jet dimensions for the quantitation of valvular regurgitation: an in vitro study using Doppler flow imaging. J Am Soc Echocardiogr. 1991;4:57–66.
Sahn DJ. Instrumentation and physical factors related to visualization of stenotic and regurgitant jets by Doppler color flow mapping. J Am Coll Cardiol. 1988;12:1354–65.
Pu M, Griffin BP, Vandervoort PM, et al. The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: a quantitative assessment integrating left ventricular function. J Am Soc Echocardiogr. 1999;12:736–43.
Thomas L, Foster E, Schiller NB. Peak mitral in flow velocity predicts mitral regurgi tation severity. J Am Coll Cardiol. 1998;31:174–9.
Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:307–32.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW, American College of Cardiology, American College of Cardiology/American Heart Association, American Heart Association. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1–32. doi:10.1016/j.jtcvs.2014.05.014. Epub 9 May 2014.
Lancellotti P, Gérard P, Piérard LA. Long term outcome of patients with heart failure and dynamic functional mitral regurgitation. Eur Heart J. 2005;26:1528–32.
Enriquez-Sarano M, Basmadjian AJ, Rossi A, et al. Progression of mitral regurgitation: a prospective Doppler echocardiographic study. J Am Coll Cardiol. 1999;34:1137–44.
Lancellotti P, Lebrun F, Piérard LA. Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol. 2003;42:1921–8.
Shiota T. Role of modern 3D echocardiography in valvular heart disease. Korean J Intern Med. 2014;29(6):685–702. doi:10.3904/kjim.2014.29.6.685. Epub 31 Oct 2014. Review.
Sugeng L, Shernan SK, Salgo IS, et al. Live 3-dimensional transesophageal echocardiography initial experience using the fully-sampled matrix array probe. J Am Coll Cardiol. 2008;52:446–9.
Biaggi P, Gruner C, Jedrzkiewicz S, et al. Assessment of mitral valve prolapse by 3D TEE. J Am Coll Cardiol Img. 2011;4:94–7.
Quader N, Rigolin VH. Two and three dimensional echocardiography for pre-operative assessment of mitral valve regurgitation. Cardiovasc Ultrasound. 2014;12:42. doi:10.1186/1476-7120-12-42.
Altiok E, Hamada S, van Hall S, et al. Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color Doppler echocardiography. Am J Cardiol. 2011;107:452–8.
Yosefy C, Levine RA, Solis J, Vaturi M, Handschumacher MD, Hung J. Proximal flow convergence region as assessed by real-time 3-dimensional echocardiography: challenging the hemispheric assumption. J Am Soc Echocardiogr. 2007;20:389–96.
Matsumura Y, Saracino G, Sugioka K, et al. Determination of regurgitant orifice area with the use of a new three-dimensional flow convergence geometric assumption in functional mitral regurgitation. J Am Soc Echocardiogr. 2008;21:1251–6.
Hopmeyer J, He S, Thorvig KM, et al. Estimation of mitral regurgitation with a hemielliptic curve-fitting algorithm: in vitro experiments with native mitral valves. J Am Soc Echocardiogr. 1998;11:322–31.
Morris M, Araoz P. Advanced imaging of mitral valve disease. US Cardiol. 2011;8:24–9.
Zeng X, Levine RA, Hua L, Morris EL, Kang Y, Flaherty M, Morgan NV, Hung J. Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography. Circ Cardiovasc Imaging. 2011;4(5):506–13. doi:10.1161/CIRCIMAGING.110.961649. Epub 5 Jul 2011.
Glockner JF, Johnston DL, McGee KP. Evaluation of cardiac valvular disease with MR imaging: qualitative and quantitative techniques. Radiographics. 2003;23:9.
Schnyder PA, Sarraj AM, Duvoisin BE, et al. Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe. AJR Am J Roentgenol. 1993;161:33–6.
Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet. 2005;365:507–18.
D’Ancona G, Mamone G, Marrone G, et al. Ischemic mitral valve regurgitation: the new challenge for magnetic resonance imaging. Eur J Cardiothorac Surg. 2007;32:475–80.
Rubinshtein R, Glockner JF, Ommen SR, et al. Characteristics and clinical significance of late gadolinium enhancement by contrast-enhanced magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Circ Heart Fail. 2010;3:51–8.
Guo YK, Yang ZG, Ning G, et al. Isolated mitral regurgitation: quantitative assessment with 64-section multidetector CT—comparison with MR imaging and echocardiography. Radiology. 2009;252:369–76.
Gelfand EV, Hughes S, Hauser TH, et al. Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson. 2006;8:503–7.
Grossman W, Baim DS. Grossman’s cardiac catheterization, angiography and intervention. 7th ed. Baltimore: Lippincott Williams and Wilkins; 2006.
Braunwald E, Awe W. The syndrome of severe mitral regurgitation with normal left atrial pressure. Circulation. 1963;27:29–35.
Chikwe J, Adams DH. State of the art: degenerative mitral valve disease. Heart Lung Circ. 2009;18:319–29.
Delahaye JP, Gare JP, Viguier E, et al. Natural history of severe mitral regurgitation. Eur Heart J. 1991;12:5–9.
Enriquez-Sarano M, Freeman WK, Tribouilloy CM, et al. Functional anatomy of mitral regurgitation: accuracy and outcome implications of TEE. J Am Coll Cardiol. 1999;34:1129–36.
Thamilarasan M, Griffin B. Choosing the most appropriate valve operation and prosthesis. Cleve Clin J Med. 2002;69:668–703.
Lee EM, Shapiro LM, Wells FC. Superiority of mitral valve repair in surgery for degenerative mitral regurgitation. Eur Heart J. 1997;18:655–63.
Enriquez-Sarano M, Schaff HV, Orszulak TA, et al. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995;91:1022–228.
Trichon BH, Felker GM, Shaw LK, et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol. 2003;91:538–43.
Ling LH, Enriquez-Sarano M, Seward JB, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996;335:1417–23.
Tribouilloy CM, Enriquez-Sarano M, Schaff HV, et al. Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical implications. Circulation. 1999;99:400–5.
Crawford MH, Souchek J, Oprian CA, et al. Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease. Circulation. 1990;81:1173–81.
Enriquez-Sarano M, Tajik AJ, Schaff HV, et al. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol. 1994;24:1536–43.
Sherrid MV, Clark RD, Cohn K. Echocardiographic analysis of left atrial size before and after operation in mitral valve disease. Am J Cardiol. 1979;43:171–8.
Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9–13.
Enriquez-Sarano M, Rossi A, Seward JB, et al. Determinants of pulmonary hypertension in left ventricular dysfunction. J Am Coll Cardiol. 1997;29:153–9.
Carabello BA. The current therapy for mitral regurgitation. J Am Coll Cardiol. 2008;52:319–26.
DiSalvo T, Acker MA, Dec GW, et al. Mitral valve surgery in advanced heart failure. J Am Coll Cardiol. 2010;55:271–82.
Bishay ES, McCarthy PM, Cosgrove DM, et al. Mitral valve surgery in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg. 2000;17:213–21.
Wu AH, Aaronson KD, Bolling SF, et al. Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol. 2005;45:381–7.
Gaasch WH, Meyer TE. Left ventricular response to mitral regurgitation: implications for management. Circulation. 2008;118:2298–303.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Chiarandà, M., Mangiafico, S., Scandura, S. (2018). Mitral Regurgitation: Diagnosis and Timing of Intervention. In: Tamburino, C., Barbanti, M., Capodanno, D. (eds) Percutaneous Treatment of Left Side Cardiac Valves. Springer, Cham. https://doi.org/10.1007/978-3-319-59620-4_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-59620-4_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-59619-8
Online ISBN: 978-3-319-59620-4
eBook Packages: MedicineMedicine (R0)