Mitral regurgitation treatment overview


 * Associate Editor-In-Chief: ; Varun Kumar, M.B.B.S ; Lakshmi Gopalakrishnan, M.B.B.S

Overview
Vasodilator therapy with ACE inhibitors and hydralazine is the foundation of medical therapy and once the patient becomes symptomatic, mitral valve surgery is the definitive therapy. This chapter reviews general treatment measures for the patient with mitral regurgitation.

Afterload Reduction

 * Afterload reduction should be instituted with the use of vasodilators such as ACE inhibitors and hydralazine.

Diuretics

 * Diuretics are useful in reducing left ventricular volumes to improve functional mitral regurgitation and to improve pulmonary edema.

Digitalis

 * Digitalis may be used to strengthen contractility, and potentially reduce hospitalization in patients with congestive heart failure.

Diet

 * A low-sodium diet may be helpful.

Activity

 * Most patients with chronic compensated mitral regurgitation have no symptoms; but if a person develops symptoms, activity should be restricted.

Beta Blockers
Beta blockers are generally not recommended as they would slow the compensatory tachycardia and would allow greater time over which the regurgitation could occur and increase the regurgitant volume.

Calcium Channel Blockers

 * In the presence of atrial fibrillation, a calcium channel blocker or digoxin can be administered to slow the heart rate down and improve left ventricular filling.

Cardioversion
Cardioversion should be considered in the patient with atrial fibrillation or flutter who is hemodynamically unstable.

Anticoagulation

 * Anti-coagulation therapy should be considered in patients with atrial fibrillation and in patients with prosthetic mitral valve replacement surgery.

Antibiotic Prophylaxis

 * Prophylactic antibiotics prior to a periodontal procedure which involves manipulation of gingival tissue, the periapical region of a tooth, or perforation of oral mucosa is recommended in patients with previous infective endocarditis, patients who have a prosthetic mitral valve implanted and in those with congentital heart disease.