Mitral Regurgitation

Abnormal reversed blood flow from LV to LA

due to abnormalities in mitral apparatus
Mitral Apparatus includes: valve leaflet,
chordae tendiane, annulus, papillary muscle,
Lt Atrium, LV myocardium surounding
papillary muscle
 Causes
1) CRHD- Chronic Rheumatic heart disease
2) Mitral valve prolapsed
3) Papillary muscle dysfunction (in AMI)
4) Rupture of chordae Tendinae- MI, SBE, trauma or spontaneous
5) Infective Endocarditis.
6) Trauma or mitral valvotomy.
7) Connective tissue disease- R. Arthritis, SLE
8) Ankylosing spondylitis
9) Cardiomyopathy (restrictive, hypertrophic, Dilated
cardiomyopathy)
10)Secondary to LV dilatation of LV, hypertension, Aortic valve
disease
 Causes of Acute MR
1. Acute myocardial infarction- due to rupture of
papillary muscle
2. Trauma or surgery (mitral valvotomy).
3. Infective Endocarditis- due to perforation of
MV leaflet or chordae.
4. Acute Rheumatic Fever (due to mitral valvulitis)
5. Spontaneous rupture of chordae or
myxomatous degeneration of valve.
 Pathophysiology
1) Regurgitant volume creates a volume overload
in LA in Systole & in LV in diastole (Volume
from LA + systolic output of RV)
LA overload causes pulmonary oedema & CCF.
LV overload causes pulmonary oedema.
In acute MR sudden onset pulmonary oedema, as
no time for LA for compensatory dilatation.
 Symptoms
1. Breathlessness – pulmonary congestion may
progress to orthopnoea.
2. Fatigue-
3. Oedema & Ascities – Rt heart failure.
4. Palpitation – AF.
 Physical Sign
Pulse – irregularly irregular if AF
Inspection – visible cardiac impulse in mitral
area
Palpation – Apex beat shifted, diffuse, thrusting
in nature, systolic thrill
 Auscultation
i) 1st heart sound soft in mitral area normal in other
area.
ii) 2nd heart sound normal in all area.
iii) 3rd heart sound may be present.
iv) Pansystolic murmur in mitral area radiating to Lt
Axilla.
v) Short MDM may be present due to increased flow
through MV
vi) S4 may present if MR of recent onset.
 D.D
1) TR
2) VSD

Complications of MR
1) Acute LVF
2) Infective endocarditis.
3) Embolism
4) AF
5) CCF
 Sign of Sever MR
i) Enlarged LV
ii) Presence of S3
iii) Presence of MDM

Investigation
i) X-ray chest P/A view - Cardiomegaly
ii) ECG – LVH may found
iii) Echocardiogram- 2D- M-Mode & Colour Doppler Study.
 Treatment
1. Medical
2. Interventional
3. Surgical
Medical
i. Diuretic
ii. Vesodilatory drug- ACE inhibitor.
iii. Digoxin- if AF
iv. Prophylaxis of CRHD .
v. Anti coaogulation – if AF or pulmonary embolism.
 Interventional
Percutaneous mitral valve repair – Mitral clip
(recently used)

Surgery
Valve replacement if Severe MR