2. Classification of Mitral regurgitation
1. Type 1 - Normal valve motion with poor co-aptation of leaflets
Ischaemic cardiomyopathy, Dilated cardiomyopathy, congenital MR
1. Type 2 - increased valve motion
RHD, degenerative MR, Trauma, Ehlers dawnload syndrome
1. Type 3 A - decreased valve motion , decreased opening of valve
RHD, Carcinoid, SLE, Mucopolysaccharides
1. Type 3 B - decreased valve motion, decreased closure of valve
Ischaemic Cardiomyopathy, dilated cardiomyopathy
3. Stages of Chronic MR
A. At risk MR -
Mild MVP with normal co-aptation of valve leaflets
Mild valve thickening & leaflet restriction
No jet / small central MR < 20% LA area
Vena contracta < 0.3
4. B. Progressive MR
Moderate MVP with normal co- aptation of valve leaflets
RHD changes +
Previous IE
Central MR jet 20-40% LA area
Vena contracta< 0.7
5. C & D- Severe MR
Severe MVP / Flail leaflet
Rheumatic valve changes with leaflet restriction
Previous IE
Moderate to severe LA enlargement
LV enlargement
PAH +
6. C1 - EF > 60%
C2 - EF < 60%
Central jet > 40% LA area or Holosystolic eccentric MR
Vena contracta > 0.7
7. Management of Primary MR
Stage D & C2 - surgery ( class 1)
If high risk for surgery , transcatheter edge - edge mitral valve repair (class 2a)
Stage C1 -
Expected surgical mortality < 1% with 95% likelihood of successful repair without
residual MR —-- Mitral valve repair ( class 2 a)
If not possible —- monitor LVEF & LV size – progressive increase in LV Size or
decrease in EF on at least 3 studies — MV repair or replacement ( class 2b)
8. Management of secondary MR
1. GDMT
2. Severe MR
If undergoing CABG - MV repair ( class 2a)
LVEF - > 50% , severe persistent symptoms even on optimal GDMT & AF
treatment —-- MV repair ( class 2b)
LVEF - < 50% , persistent symptoms on GDMT - if mitral valve anotomy
favourable - transcatheter edge to edge MV repair ( class 2a) —- if not MV
surgery ( class 2b)
