Management of Acute Mitral Regurgitation.pptx

1. Acute Mitral Regurgitation

2. 2014 AHA/ACC guideline for the management of patients
with Acute Mitral Regurgitation
A report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines.
Management of Acute Mitral Regurgitation

3. • TTE is the initial imaging modality of choice to evaluate LV function, RV
function, pulmonary artery pressure, and mechanism of MR.
• The patient with severe acute MR, which might occur from chordal rupture,
usually experiences acute hemodynamic decompensation.
• The sudden volume overload increases LA and pulmonary venous pressures,
leading to pulmonary congestion and hypoxia, whereas decreased blood
delivery to the tissues with a concomitant decrease in LV systolic pressure
limits the pressure gradient, driving MR to early systole. Thus, the murmur
may be short and unimpressive, as may be the color jet of MR by TTE.
Diagnosis
Management of Acute Mitral Regurgitation

4. Management of Acute Mitral Regurgitation
Medical Therapy
• Vasodilator therapy improves hemodynamic compensation in acute MR. The premise
for use of vasodilators in acute MR is a reduction in impedance of aortic flow, thereby
preferentially guiding flow away from the LV-to-LA pathway, decreasing MR while
simultaneously increasing forward output to the LV-to-aortic.
• Use of vasodilators is often limited by systemic hypotension that is exacerbated when
peripheral resistance is decreased.

5. Management of Acute Mitral Regurgitation
Medical Therapy
• Intra-aortic balloon counter pulsation can be helpful to treat acute severe MR. By
lowering systolic aortic pressure, intra-aortic balloon counter pulsation decreases
LV afterload, increasing forward output while decreasing regurgitant volume.
• Simultaneously, intra-aortic balloon counter pulsation increases diastolic and mean
aortic pressures, thereby supporting the systemic circulation.
• The use of a percutaneous circulatory assist device may stabilize a patient with
acute hemodynamic compromise before the procedure.

6. Management of Acute Mitral Regurgitation
Intervention
• Prompt mitral valve surgery, preferably mitral repair if possible, is lifesaving in the
symptomatic patient with acute severe primary MR.
• The severity of acute primary MR is variable, and some patients with more
moderate amounts of MR may develop compensation as LV dilation allows for
lower filling pressure and increased forward cardiac output.
• Most patients with acute severe MR require surgical correction for reestablishment
of normal hemodynamics and for relief of symptoms.