Mitral valve regurgitation

KVO Keep vein open MVR Mitral valve replacement mitral valve regurgitation... 

A 55-year-old man is admitted to the ED for VT. Vital signs BP 105/86 mm Hg, HR 138 beats/min, and RR 20 breaths/min. PMH diabetes, CHF, atrial flutter, mitral valve regurgitation, and HTN. Labs are within normal limits except for a slightly low serum sodium. What is a reason for starting lidocaine at a lower dose in this patient ... 

Only a few reports exist that deal with the accuracy of MDCT for detecting and quantifying mitral valve disease, i.e., mitral valve regurgitation and/or stenosis (Alkadhi et al. 2006 Messika-Zeitoun et al. 2006) (Fig. 19.6). Very little information is available on the usefulness of MDCT for the diagnosis of pulmonary valve and tricuspid valve disease. Thus, the value of MDCT in diseases of the mitral valve, pulmonary valve, and tricuspid valve is still unclear, and echocar-... 

Mitral stenosis or regurgitation Mitral valve prolapse Chronic obstructive pulmonary disease Pulmonary embolism Idiopathic ("lone" atrial fibrillation) Thoracic surgery ... 

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. 

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. 

Risk factors include the following prosthetic heart valves, previous bacterial endocarditis, congenital cardiac malformations, rheumatic and other acquired valvular dysfunction, and mitral valve prolapse with valvular regurgitation. 

Indications for surgical intervention include regurgitation with NYHA lll-IV symptoms or NHYA >11 with atrial fibrillation refractory to conservative treatment. Several surgical techniques are effective, The Alfieri stitch or edge to edge technique is of interest because one of the percutaneous mitral valve repair techniques is based on an equivalent principle (29,30). Currently two methods for transcatheter mitral valve repair are investigated in clinical trials ... 

I. In 1991, the surgical variant of the edge-to-edge repair technique was first tried in patients that were not suitable for complex mitral valve repair (29). This procedure is still performed with the intention of sewing together part of the free edges of the anterior and posterior valve leaflets in such a way as to construct a double orifice valve to decrease regurgitation. 

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. 

Mitral valve prolapsemild prolapse of the mitral (bicuspid) valve of the heart is common and occurs in approximately 11 percent of the population. More serious is mitral regurgitation, which allows blood from the left ventricle to backflow into the left atrium because of incomplete closure of the valve. 

Surgically constructed systemic pulmonary shunts or conduits Acquired valvular dysfunction (e.g., rheumatic heart disease) Hypertrophic cardiomyopathy Mitral valve prolapse with regurgitation Intravenous drug abuse... 

In the past, rheumatic heart disease was a prevalent risk factor for IE, but the incidence of this disease continues to decline. The risk of IE in persons with mitral valve prolapse and regurgitation is small however, because the condition is prevalent, it is an important contributor to the overall number of IE cases. Prosthetic valve endocarditis occurs in 1 % to 4% of patients undergoing valve replacement surgery. ... 

Moderate-risk conditions Mitral valve prolapse with valvular regurgitation or leaflet thickening, isolated mitral stenosis, tricuspid-valve disease, pulmonary stenosis, and hypertrophic cardiomyopathy... 

Low- or no-risk conditions Secundum atrial septal defect, ischemic heart disease, previous coronary artery bypass graft surgery, and mitral valve prolapse with thin leaflets in the absence of regurgitations Temperature >38°C (100.4°F)... 

Mitral valve prolapse with valvar regurgitation and/or thickened leaflets... 

Previous coronary artery bypass graft surgery Mitral valve prolapse without valvar regurgitation Physiologic, functional, or innocent heart murmurs Previous Kawasaki disease without valvar dysfunction Previous rheumatic fever without valvar dysfunction Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators... 

Importantly, left atrial remodeling is reversible. Studies have shown that LA size and function can improve with certain medications, after restoration of sinus rhythm from AF and after repair of the mitral valve in the case of severe mitral regurgitation. Direct evidence of reversing LA remodeling on cardiovascular outcomes remains to be seen, but the evidence indirectly suggests that the risk of AF can be significantly reduced. 

Normal mitral valve function requires intact leaflet structure, preserved subvalvular apparatus (i.e., chordae tendinae and papillary muscles), and a nondi-lated mitral annulus. Disruption of any one of these elements can lead to regurgitation of blood into the left atrium under the high pressure of left ventricular systole. 

The most common cause of primary mitral regurgitation in the developed world is mitral valve prolapse... 

Medical treatment of mitral regurgitation with afterload reduction and diuresis can effectively alleviate symptoms, but has not been shown to prolong survival. The currently recommended treatments for severe mitral regurgitation are surgical mitral valve repair or replacement. Mitral valve replacement with either a bioprosthetic or mechanical valve has the inherent drawbacks of a potential increase in periprocedural... 

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