Modern Diagnostical Criteria For Mitral Regurgitation

Abstract

Introduction: Regurgitation means backward movement against the normal movement. In digestive system it can be characterised by vomiting. Mitral regurgitation which is sometimes known as mitral insufficiency is leakage of blood backward through the mitral valve each time the left ventricle contracts. It can be caused by mitral prolapse due to myxomatous degeneration, ischemic heart disease, rheumatic heart disease, valvular endocarditis, atherosclerotic lesion if the mitral leaflets, trauma, Marfan’s syndrome. Mitral regurgitation can be classified as Acute and Chronic. Acute mitral regurgitation is usually associated with coronary artery disease and acute myocardial infarction (typically, inferior myocardial infarction, which may lead to papillary muscle dysfunction), bacterial endocarditis or trauma and is always accompanied by symptoms of impaired LV function, such as dyspnea, fatigue, and orthopnea Chronic mitral regurgitation results from a primary defect of the mitral valve apparatus with subsequent progressive enlargement of the left atrium and ventricle, and usually is accompanied with symptoms like fatigue, dyspnea on exertion, or shortness of breath. Case report. A 52-year-old woman presents with dyspnoea on exertion, fatigue, and occasional palpitations. She has no prior cardiac history. She denies chest pain, orthopnoea, paroxysmal nocturnal dyspnoea, or lower extremity oedema. On physical examination her jugular venous distension is around 12 cm and her lungs are clear to auscultation. Cardiac examination reveals a slightly displaced apical impulse with a palpable P2. Cardiac auscultation reveals III/VI holosystolic murmur at the apex that radiates to the axilla with diminished S1 and P2 greater than A2. On ECG, P-mitrale is registered in I, AVL, V6 leads. On ultrasound examination, grade 2A mitral regurgitation and mild dilation of left atrium are observed. Conclusion. Mitral valve regurgitation treatment depends on how severe the patient’s condition is, if he/she is experiencing signs and symptoms, and if the condition is getting worse. The goal of treatment is to improve heart's function while minimizing signs and symptoms of heart failure and avoiding future complications. Echocardiography is the essential and the most sensitive method to diagnose mitral regurgitation. Early surgery is usually recommended in grade 2B-3 mitral regurgitation as well in case of severe, treatment-resistant symptoms of heart failure.