Mitral regurgitation

Systolic dysfunction Improved hemodynamic performance -decreased end-diastolic dimension -decrease filling pressure -decreased systolic pressure -decreased SVR -decreased mitral regurgitation Arterial vasodilation... 

Secondary mitral regurgitation can be a consequence of intraventricular conduction delay. Secondary mitral regurgitation is a common accompaniment of dilated cardiomyopathy of ischemic etiology. Intraventricular conduction delays can create or exacerbate mitral regurgitation by causing a lack of coordination of the papillary muscles [95]. The geometry of the mitral papillary muscles places one near... 

Appleton CP, Basnight MA, Gonzalez MS. Diastolic mitral regurgitation with atrioventricular conduction abnormalities relation of mitral flow velocity to transmittal pressure gradients in conscious dogs. J. Am. Coll. Cardiol. 1991 18 843-9. 

Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LE, Gorcsan J, III. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy insights from mechanical activation strain mapping. J. Am. Coll. Cardiol. 2004 44 1619-25. 

Berglund H, Nishioka T, Hackner E, et al. Ventricular pacing a cause of reversible severe mitral regurgitation. Am. Heart J. 1996 131 1035-7. 

Sassone B, De Simone N, Parlangeli G, Tortorici R, Biancoli S, Di Pasquale G. Pacemaker-induced mitral regurgitation prominent role of abnormal ventricular activation sequence versus altered atrioventricular synchrony. Ital. Heart J. 2001 2 441-8. 

Hanna SR, Chung ES, Aurigemma GP, Meyer TE. Worsening of mitral regurgitation secondary to ventricular pacing. J. Heart Valve Dis. 2000 9 273-5. 

Cannan CR, Higano ST, Holmes DR, Jr. Pacemaker induced mitral regurgitation an alternative form of pacemaker syndrome. Pacing Clin. Electrophysiol. 1997 20 735-8. 

Lowes BD, Gill EA, Abraham WT, et al. Effects of carvedilol on left ventricular mass, chamber geometry, and mitral regurgitation in chronic heart failure. Am. J. Cardiol. 1201 83 1201-5. 

Valve surgery with severe aortic stenosis or mitral regurgitation... 

Tkacova R, Liu PP, Naughton MT, et al. Effect of continuous positive airway pressure on mitral regurgitant fraction and atrial natriuretic peptide in patients with heart failure. JAm Coll Cardiol. Sep 1997 30(3) 739-745. 

No data exist regarding the efficacy of antiarrhythmic therapy in mitral valve prolapse patients with hemodynamically significant mitral regurgitation. At present, /3-blockers seem preferable when ventricular performance permits. Class I agents should be used with careful follow-up by ambulatory monitoring and/or exercise testing to avoid any proar-rhythmic effects. 

C) The concept of afterload reduction is principally derived from patients of significant mitral regurgitation. 

Unlabeled Uses Graft patency (saphenous vein), mitral regurgitation, mitral stenosis, noncardioembolic stroke, percutaneous coronary intervention... 

In other conditions of cardrogenic shock (due to mechanical abnormalities) e.g. acute mitral regurgitation or ventricular septal defect, surgical correction is usually required. 

It is indicated in hypertensive crisis, congestive heart failure and acute mitral regurgitation. 

Mitral regurgitation, < 100 > 20 < 2.5 Vasodilators, inotropic drugs, circulatory... 

Rheumatic mitral valve disease is associated with thromboembolic complications at reported rates of 1.5 to 4.7% per year the incidence in patients with mitral stenosis is approximately 1.5 to 2 times that in patients with mitral regurgitation. The presence of atrial fibrillation is the single most important risk factor for thromboembolism in valvular disease, increasing the incidence of thromboembolism in both mitral stenosis and regurgitation four- to sevenfold. In current practice, patients with nonrheumatic atrial fibrillation at low risk for thromboembolism based on clinical characteristics frequently are treated with aspirin. Warfarin therapy is considered in higher-risk patients, especially those with previous thromboembolism and in whom anticoagulation is not contraindicated due to preexisting conditions. 

Clinical benefits and effects on mortality and hospitalization Whether used alone or in combination, hydralazine and isosorbide dinitrate decrease the preload and afterload, decrease mitral regurgitation, improve cardiac output, increase exercise capacity, modestly increase LVEF and prolong survival in patients with HF (63,64). V-Heart Failure Trial (HeFT) II (64) showed that enalapril had a major benefit on survival when compared with the combination of hydralazine-isosorbide dinitrate with enalapril in patients with predominantly NYHA class ll-lll. The African Americans in Heart Failure Trial (A-HeFT) (65) showed a beneficial effect of adding vasodilator therapy to African-American patients already treated with ACE inhibitors, (3 blockers, and spironolactone. There are no results with the same strategy in other patient groups. 

LiddicoatJR, Mac Neill BD, Gillinov AM, et al. Percutaneous mitral valve repair a feasibility study in an ovine model of acute ischemic mitral regurgitation. Catheter Cardiovasc Interv 2003 60 410-416. 

Maniu CY Patel JB, Reuter DG, et al. Acute and chronic reduction of functional mitral regurgitation in experimental heart failure by percutaneous mitral annuloplasty. J Am Coll Cardiol 2004 44 1652-1661. 

A 66-year-old woman with mitral regurgitation and atrial fibrillation developed hypokalemia and a variety of rhythm disturbances at dosages of 40 mg or more per day. 

A 76-year-old woman, who had a history of hypertension, valvular heart disease (mitral regurgitation) with chronic atrial fibrillation, chronic obstructive airways disease, diverticular disease of the sigmoid colon, and generalized anxiety disorder, developed severe hypotension with a tachycardia after taking alprazolam for 7 days. She also had severe weakness, depressed mood, and impaired gait and balance, without clinical features of neuromuscular disease. 

Mitral leaflet prolapse is a common incidental finding. It can be complicated by gross mitral regurgitation, infective endocarditis, atrial fibrillation and left atrial thrombus and thus embolism to the brain. However, there is no excess risk of first or recurrent stroke in patients with uncomplicated mitral leaflet prolapse (Orencia et al. 1995a, b). 

This was an unusual study because patients enrolled for a different purpose were analysed mid-way through the study in response to withdrawal of fenfluramine. Exposure to fenfluramine in this study was relatively short (2-3 months) and the prevalences of mitral regurgitation and aortic regurgitation in this study were much lower than previously described (25). 

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