Mitral Regurgitation (Mitral Insufficiency)

1. MITRAL
REGURGITATION
(MITRAL
INSUFFIСIENCY)

2. Symptoms:Symptoms:
In case of rheumatic origin the signs
and symptoms are developing after
many years. When symptoms occur,
they usually develope slowly. Fatigue,
perhaps attribute to the low cardiac
output, can be the first complaint, but
than dyspnoea on exertion, orthopnoea
and paroxysmal nocturnal dyspnoea
develop.

3. When mitral regurgitation ariseWhen mitral regurgitation arise
due to the perforation of a cusp, ordue to the perforation of a cusp, or
rupture of chordae tendineae orrupture of chordae tendineae or
papillary muscles, then onsetpapillary muscles, then onset
symptoms arise: the patient maysymptoms arise: the patient may
suffer from acute pulmonarysuffer from acute pulmonary
edema.edema.

4. Physical signs:Physical signs:
The pulse is usually of normal volume:
irregularity due to atrial fibrillation is
common. The arterial pressure can be
normal or can increase. The apex beat,
can displaced downwards and outwards,
due to of left ventricular hypertrophy and
dilatation, and there is sometimes a
systolic thrill. The heart borders widened
to the upper, to the left, to the right.

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6. The first sound is usually softThe first sound is usually soft
and produce an apicaland produce an apical
pansystolic murmur, whichpansystolic murmur, which
radiates to the axilla. In mostradiates to the axilla. In most
severe cases there is a thirdsevere cases there is a third
heart sound. Second heartheart sound. Second heart
sound on pulmonary artery issound on pulmonary artery is
accentuated.accentuated.

7. The ECGThe ECG
The ECG may be normal but
P mitral is often present if atrial
fibrillation has not supervened. Left
ventricular hypertrophy occurs in
severe mitral regurgitation.

8. Radiography andRadiography and
echocardiographyechocardiography
Radiologically, the most important
feature is the marked enlargement of left
atrium, but there may also be left
ventricular enlargement.
Calcification and deformation mitral
valve,mitral regurgitation is direct sign .
Evidence of pulmonary dilatation and
pulmonary odema develops when there
is left ventricular failure.

9. Echocardiography may notEchocardiography may not
reveal any abnormality inreveal any abnormality in
mitral regurgitation, but if themitral regurgitation, but if the
reflex is large, there isreflex is large, there is
dilatation of the left atrium anddilatation of the left atrium and
left ventricle, and hypertrophyleft ventricle, and hypertrophy
of right ventricle.of right ventricle.

10. Calcification or thickening ofCalcification or thickening of
the cusps can be seen. Otherthe cusps can be seen. Other
possible findings includepossible findings include
mitral valve prolapse or a flailmitral valve prolapse or a flail
valve due to ruptured chordaevalve due to ruptured chordae
or papillary muscles.or papillary muscles.
Doppler ultrasound is goodDoppler ultrasound is good
technique for demonstratingtechnique for demonstrating
mitral regurgitation.mitral regurgitation.

12. Course and prognosis:Course and prognosis:
The course of patients with mitral
regurgitation is very variable. Those with
mild regurgitation and without
cardiomegaly may live a normal life
span. In rheumatic mitral regurgitation of
moderate severity, the course is one of
slow deterioration over 10-20 years with
gradually increasing heart size until left
ventricular failure develops.

13. When mitral regurgitation ariseWhen mitral regurgitation arise
due to the ruptured chordaedue to the ruptured chordae
tendineae, papillary muscles ortendineae, papillary muscles or
cusps, the prognosis is generallycusps, the prognosis is generally
poor, although the regurgitation ispoor, although the regurgitation is
occasionally slight and welloccasionally slight and well
tolerable.tolerable.

14. treatment rheumatictreatment rheumatic
fever,symptomatical therapy)fever,symptomatical therapy)
Surgical treatment:
Mitral regurgitation can be
successfully treated surgically only
under direct vision, with
cardiopulmonary bypass. In many
cases, however, it is necessary to
insert a mitral valve prosthesis.