Congestive heart failure and mitral regurgitation

Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School

Indications for MVr/R
1. Mitral regurgitation of 3+ or 4+

and any of the conditions below:

2. History of prior heart failure or congestive heart failure

or

3. Tricuspid regurgitation gradient ≥ 30 mmHg

or

4. History of prior atrial fibrillation

or

5. The left ventricular ejection fraction (LVEF) is ≤ 60%

or

6. The left ventricular end-systolic dimension is ≥ 40mm

Background

 * Mitral regurgitation is highly associated with systolic heart failure as a cause, sequela, or complication. It confers independently and significantly increased mortality, regardless of its etiology or of the symptom status of the patient. Medical therapy has no significant impact on mortality associated with moderate to severe mitral regurgitation.


 * Corrective intervention consists of mitral valve replacement (MVR) and mitral valve repair (MVr). Adhering to AHA guidelines for the timing of corrective intervention in patients with 3+/4+ mitral regurgitation is highly effective at improving or, in the subset of asymptomatic patients with normal left ventricular function, normalizing longevity.


 * Mitral valve repair, when technically practicable, is associated with a superior hemodynamic and physiological result, with lower risk of hemorrhagic, thromboembolic, and infectious complications when compared with mitral valve replacement.