Valvular Disease and Heart Failure: Mitral Regurgitation

  • Ravi V. Shah
  • G. William Dec
Part of the Clinical Cases in Cardiology book series (CCC)


A 75-year-old female with a past medical history of type 2 diabetes mellitus, hypertension, and implantable cardioverter-defibrillator (ICD) and chronic left ventricular systolic dysfunction for over 5 years presented with increasing exertional dyspnea. Three months ago, she suffered syncope with ICD interrogation with ventricular fibrillation, and successful delivery of shock therapy. At that time, she underwent coronary angiography that demonstrated no obstructive coronary artery disease. An echocardiogram demonstrated LV ejection fraction 15% and a dilated left ventricle (end-diastolic dimension by M-mode echocardiography 81 mm) with decreased right ventricular function and severe mitral regurgitation (MR). There is no evidence of mitral valve prolapse, prior endocarditis, or other valve leaflet pathology. Of note, the MR has been present for the past 2 years, with a slow, progressive dilatation of the LV, though she has remained relatively asymptomatic (class I–II) with most daily activities. She is on carvedilol 12.5 mg twice a day, lisinopril 5 mg daily, and furosemide 20 mg twice a day.


Mitral valve insufficiency Left sided heart failure 


  1. 1.
    Allen LA, Felker GM. Advances in the surgical treatment of heart failure. Curr Opin Cardiol. 2008;23(3):249–53.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gertz ZM, Raina A, Saghy L, Zado ES, Callans DJ, Marchlinski FE, Keane MG, Silvestry FE. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol. 2011;58(14):1474–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Levine RA, Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005;112(5):745–58.CrossRefPubMedGoogle Scholar
  4. 4.
    Carabello BA, Nakano K, Corin W, Biederman R, Spann JF Jr. Left ventricular function in experimental volume overload hypertrophy. Am J Phys. 1989;256(4 Pt 2):H974–81.Google Scholar
  5. 5.
    Bursi F, Barbieri A, Grigioni F, Reggianini L, Zanasi V, Leuzzi C, Ricci C, Piovaccari G, Branzi A, Modena MG. Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: a long-term outcome study. Eur J Heart Fail. 2010;12(4):382–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Capomolla S, Febo O, Gnemmi M, Riccardi G, Opasich C, Caporotondi A, Mortara A, Pinna GD, Cobelli F. Beta-blockade therapy in chronic heart failure: diastolic function and mitral regurgitation improvement by carvedilol. Am Heart J. 2000;139(4):596–608.CrossRefPubMedGoogle Scholar
  7. 7.
    Comin-Colet J, Sanchez-Corral MA, Manito N, Gomez-Hospital JA, Roca J, Fernandez-Nofrerias E, Valdovinos P, Esplugas E. Effect of carvedilol therapy on functional mitral regurgitation, ventricular remodeling, and contractility in patients with heart failure due to left ventricular systolic dysfunction. Transplant Proc. 2002;34(1):177–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Ypenburg C, Lancellotti P, Tops LF, Bleeker GB, Holman ER, Pierard LA, Schalij MJ, Bax JJ. Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation. J Am Coll Cardiol. 2007;50(21):2071–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Breithardt OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A, Stellbrink C. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol. 2003;41(5):765–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.CrossRefPubMedGoogle Scholar
  11. 11.
    Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery, Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96.CrossRefGoogle Scholar
  12. 12.
    Milano CA, Daneshmand MA, Rankin JS, Honeycutt E, Williams ML, Swaminathan M, Linblad L, Shaw LK, Glower DD, Smith PK. Survival prognosis and surgical management of ischemic mitral regurgitation. Ann Thorac Surg. 2008;86(3):735–44.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Massachusetts General HospitalBostonUSA

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