A REVIEW ON MITRAL REGURGITATION: PATHOPHYSIOLOGY, INVESTIGATIONS AND TREATMENT

Main Article Content

OMAR ELSAKA
MONEER AYMAN NOURELDEAN
MOHAMED ADEL GAMIL
MOSTAFA TAREK GHAZALI
ASHRAF HAMADA ABD AL-RAZIK
DALIA HISHAM

Abstract

Background: The retrograde movement of blood from the left ventricle (LV) into the left atrium (LA) through the mitral valve (MV) causes a systolic murmur heard best at the apex of the heart with radiation to the left axilla. MR is the most common valvular anomaly in the globe, affecting around 2% of the population and increasing in incidence with age. This activity examines the diagnosis and treatment of mitral regurgitation, emphasizing the importance of the healthcare team in assessing and treating patients with this illness.

Conclusion: The goal of this review article is to identify the etiology and epidemiology of mitral regurgitation medical conditions and emergencies, review the proper history, physical, and evaluation of mitral regurgitation, outline the treatment and management options for mitral regurgitation, and describe interprofessional team strategies for improving care coordination and communication to advance mitral regurgitation and improve outcomes.

Keywords:
Echocardiography, heart failure, mitral regurgitation, Mechanism, mitral annulus, papillary muscles

Article Details

How to Cite
ELSAKA, O., NOURELDEAN, M. A., GAMIL, M. A., GHAZALI, M. T., AL-RAZIK, A. H. A., & HISHAM, D. (2022). A REVIEW ON MITRAL REGURGITATION: PATHOPHYSIOLOGY, INVESTIGATIONS AND TREATMENT. Asian Journal of Advances in Medical Science, 4(1), 15-28. Retrieved from http://mbimph.com/index.php/AJOAIMS/article/view/2741
Section
Review Article

References

Abdel Fattah EM, Girgis HY, El Khashab K, Ashour ZA, Ezzat GM. B-type Natriuretic Peptide as an Index of Symptoms and Severity of Chronic Rheumatic Mitral Regurgitation. Heart Views. 2016;17(1):7-12.

Alegria-Barrero E, Franzen OW. Mitral Regurgitation - A Multidisciplinary Challenge. Eur Cardiol. 2014;9(1):49-53.

Andalib A, Chetrit M, Eberg M, Filion KB, Thériault-Lauzier P, Lange R, Buithieu J, Martucci G, Eisenberg M, Bolling SF, Piazza N. A Systematic Review and Meta-Analysis of Outcomes Following Mitral Valve Surgery in Patients with Significant Functional Mitral Regurgitation and Left Ventricular Dysfunction. J Heart Valve Dis. 2016;25(6): 696-707.

Apostolidou E, Maslow AD, Poppas A. Primary mitral valve regurgitation: Update and review. Glob Cardiol Sci Pract. 2017; (1):e201703.

Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol. 2015; 65(12):1231-1248.

Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS., Writing Committee Members. American College of Cardiology/American Heart Association Task Force. Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(15):e523-661.

Borer JS, Sharma A. Drug Therapy for Heart Valve Diseases. Circulation. 2015;132(11): 1038-45.

Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis. 2003;12(5):577-81.

Coleman W, Weidman-Evans E, Clawson R. Diagnosing and managing mitral regurgitation. JAAPA. 2017;30(6):11-14.

Costa FDAD, Colatusso DFF, Martin GLDS, Parra KCS, Botta MC, Balbi Filho EM, Veloso M, Miotto G, Ferreira ADA, Colatusso C. Long-Term Results of Mitral Valve Repair. Braz J Cardiovasc Surg. 2018;33(1):23-31.

Dal-Bianco JP, Beaudoin J, Handschumacher MD, Levine RA. Basic mechanisms of mitral regurgitation. Can J Cardiol. 2014;30(9):971-81.

DePace NL, Nestico PF, Morganroth J. Acute severe mitral regurgitation. Pathophysiology, clinical recognition, and management. Am J Med. 1985;78(2):293-306.

Dziadzko V, Clavel MA, Dziadzko M, Medina-Inojosa JR, Michelena H, Maalouf J, Nkomo V, Thapa P, Enriquez-Sarano M. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet. 2018; 391(10124):960-969.

Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373 (9672):1382-94.

Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005; 352(9):875-83.

Gertz ZM, Raina A, Saghy L, Zado ES, Callans DJ, Marchlinski FE, Keane MG, Silvestry FE. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol. 2011;58(14):1474-81.

Ginghină C, Vlădaia A, Ghiorghiu I, Serban M, Popescu BA, Jurcuţ R. Echocardiography in congenital mitral valve regurgitation--the liaison between cardiologist and surgeon. J Med Life. 2009;2(4):407-13.

Grayburn PA, Carabello B, Hung J, Gillam LD, Liang D, Mack MJ, McCarthy PM, Miller DC, Trento A, Siegel RJ. Defining "severe" secondary mitral regurgitation: emphasizing an integrated approach. J Am Coll Cardiol. 2014; 64(25):2792-801.

Harari R, Bansal P, Yatskar L, Rubinstein D, Silbiger JJ. Papillary muscle rupture following acute myocardial infarction: Anatomic, echocardiographic, and surgical insights. Echocardiography. 2017;34(11):1702-1707.

Herrmann HC, Gertz ZM, Silvestry FE, Wiegers SE, Woo YJ, Hermiller J, et al.Effects of atrial fibrillation on treatment of mitral regurgitation in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) randomized trial. J Am Coll Cardiol. 2012;59(14):1312-9.

Heuts S, Olsthoorn JR, Hermans SMM, Streukens SAF, Vainer J, Cheriex EC, Segers P, Maessen JG, Sardari Nia P. Multidisciplinary decision-making in mitral valve disease: the mitral valve heart team. Neth Heart J. 2019;27(4):176-184.

Hwang HJ, Choi EY, Kwan J, Kim SA, Shim CY, Ha JW, Rim SJ, Chung N, Kim SS. Dynamic change of mitral apparatus as potential cause of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Eur J Echocardiogr. 2011;12(1):19-25.

Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC). European Association for Cardio-Thoracic Surgery (EACTS). Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451-96.

Katz WE, Conrad Smith AJ, Crock FW, Cavalcante JL. Echocardiographic evaluation and guidance for MitraClip procedure. Cardiovasc Diagn Ther. 2017;7(6):616-632.

Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL., European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(4):307-32.

Lindmark K, Söderberg S, Teien D, Näslund U. Long-term follow-up of mitral valve regurgitation--importance of mitral valve pathology and left ventricular function on survival. Int J Cardiol. 2009;137(2): 145-50.

Lunel C, Laurent M, Corbineau H, Boulmier D, Chaperon J, Guillo P, Dewitte JD, Leguerrier A. [Return to work after cardiac valvular surgery. Retrospective study of a series of 105 patients]. Arch Mal Coeur Vaiss. 2003; 96(1):15-22.

Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc. 2010;85(5):483-500.

Mehta NK, Kim J, Siden JY, Rodriguez-Diego S, Alakbarli J, Di Franco A, Weinsaft JW. Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery. J Thorac Dis. 2017 ;9(Suppl 4):S246-S256.

Moraes RC, Katz M, Tarasoutchi F. Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department. Einstein (Sao Paulo). 2014 ;12(2):154-8.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135(25):e1159-e1195.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD., American College of Cardiology/American Heart Association Task Force on Practice Guidelines. AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):2438-88.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD., ACC/AHA Task Force Members. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92.

Nkomo VT. Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa. Heart. 2007;93 (12):1510-9.

O'Gara PT, Grayburn PA, Badhwar V, Afonso LC, Carroll JD, Elmariah S, Kithcart AP, Nishimura RA, Ryan TJ, Schwartz A, Stevenson LW. 2ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70(19):2421-2449.

Patel JB, Borgeson DD, Barnes ME, Rihal CS, Daly RC, Redfield MM. Mitral regurgitation in patients with advanced systolic heart failure. J Card Fail. 2004;10(4):285-91.

Pollmann AGE, Frederiksen M, Prescott E. Cardiac Rehabilitation After Heart Valve Surgery: Improvement in Exercise Capacity and Morbidity. J Cardiopulm Rehabil Prev. 2017;37(3):191-198.

Rouskas P, Giannakoulas G, Kallifatidis A, Karvounis H. Parachute-like mitral valve as a cause of mitral regurgitation. Hippokratia. 2016;20(3):238-240.

Sharma A, Agrawal S, Goel S, Borer JS. Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement. Curr Cardiol Rep. 2017;19(1):3.

Sibilitz KL, Berg SK, Rasmussen TB, Risom SS, Thygesen LC, Tang L, Hansen TB, Johansen PP, Gluud C, Lindschou J, Schmid JP, Hassager C, Køber L, Taylor RS, Zwisler AD. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart. 2016;102(24):1995-2003.

Slipczuk L, Rafique AM, Davila CD, Beigel R, Pressman GS, Siegel RJ. The Role of Medical Therapy in Moderate to Severe Degenerative Mitral Regurgitation. Rev Cardiovasc Med. 2016;17(1-2):28-39.

Spartalis M, Tzatzaki E, Spartalis E, Athanasiou A, Moris D, Damaskos C, Garmpis N, Voudris V. Mitral valve prolapse: an underestimated cause of sudden cardiac death-a current review of the literature. J Thorac Dis. 2017;9(12):5390-5398.

Stout KK, Verrier ED. Acute valvular regurgitation. Circulation. 2009;119(25):3232-41.

Supino PG, Khan N, Hai O, Herrold EM, Hochreiter C, Borer JS. Relation of indirect vasodilator use to prognosis in patients with chronic severe mitral regurgitation. Cardiology. 2014;129(4):262-6.

Tomšič A, Hiemstra YL, van Hout FMA, van Brakel TJ, Versteegh MIM, Marsan NA, Klautz RJM, Palmen M. Long-term results of mitral valve repair for severe mitral regurgitation in asymptomatic patients. J Cardiol. 2018;72(6):473-479.

Uretsky S, Argulian E, Narula J, Wolff SD. Use of Cardiac Magnetic Resonance Imaging in Assessing Mitral Regurgitation: Current Evidence. J Am Coll Cardiol. 2018;71(5):547-563.

Varma PK, Krishna N, Jose RL, Madkaiker AN. Ischemic mitral regurgitation. Ann Card Anaesth. 2017;20(4):432-439.

Writing Committee Members. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-327.

Wu S, Chai A, Arimie S, Mehra A, Clavijo L, Matthews RV, Shavelle DM. Incidence and treatment of severe primary mitral regurgitation in contemporary clinical practice. Cardiovasc Revasc Med. 2018;19(8):960-963.

Zeng X, Levine RA, Hua L, Morris EL, Kang Y, Flaherty M, Morgan NV, Hung J. Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography. Circ Cardiovasc Imaging. 2011;4(5):506-13.

Zhuge RQ, Hou XP, Qi XL, Wu YJ, Zhang MZ. Clinical features and treatment options for mitral regurgitation in elderly inpatients. J Geriatr Cardiol. 2018;15(6):428-433.

Most read articles by the same author(s)