Mitral Regurgitation Treatment, Symptoms, Causes, Diagnosis

When the flaps of the mitral valve do not shut completely, it results in mitral valve regurgitation, a disorder that affects the heart valves and causes blood to flow backward to the heart. Blood flow from the left atrium to the left ventricle is regulated by the mitral valve's flaps, also known as valve leaflets or cusps. Blood may leak in the incorrect way if a valve is not closed tightly enough or if its size or shape are changed. This leak, which is the most prevalent type of heart valve illness, is also known as mitral regurgitation (MR) or mitral valve insufficiency.

There are two forms of regurgitation of the mitral valve:

• When the mitral valve itself is defective, degenerative mitral regurgitation takes place. The flaps may not seal tightly and may droop or protrude.
• Functional mitral regurgitation: This condition occurs when the leakage is brought on by a problem unrelated to the valve, such as a condition affecting the left ventricle. Even if your valve flaps are normal, you could be given a functional mitral regurgitation diagnosis.

Read this blog further to get a quick overview of this important topic for anatomy and ace your NEET PG exam preparation.

Causes of mitral regurgitation:

Causes of acute mitral regurgitation

• Infective endocarditis/subacute bacterial endocarditis
• Papillary muscle damage due to Myocardial Infarction
• Most commonly involved leaflet is the posteromedial leaflet (then anterolateral leaflet).
• Mitral Valve Prolapse / Flail leaflets (Myxomatous degeneration)
• Blunt trauma to chest cause Commotio cordis (Due to Ventricular fibrillation) causing “sudden cardiac death”

Causes of chronic mitral regurgitation

Primary: Intrinsic damage to valve. Leaflets or chordae tendineae are diseased and there is structural damage. Causes are:

• Mitral Valve Prolapse (myxomatous degeneration)
• Aschoff nodules of rheumatic fever  
• Infective endocarditis 
• Congenital cause: Cleft mitral valve due to ostium primum (Atrial Septal Defect)

Secondary- Due to Annular dilatation of mitral valve (also known as functional dilatation). Causes are:

• Ischemic cardiomyopathy
• Dilated Cardiomyopathy 
• Hypertrophic Obstructive Cardiomyopathy with Systolic anterior displacement of mitral valve.
• In chronic atrial fibrillation, there is left atrial enlargement, and mitral valve annulus gets affected 
• Most Common characteristic finding occurring in secondary varieties is Mitral annular dilatation

Symptoms of Mitral Valve Regurgitation

Regurgitation of the mitral valve frequently develops slowly and without any obvious symptoms. You could have symptoms of heart valve disease as the condition worsens, such as:

Mild to moderate Mitral Regurgitation is well tolerated

In severe cases:

• Fatigue
• PND (Paroxysmal nocturnal dyspnoea)
• Orthopnoea 
• Ankle edema

 Examination

• Blood Pressure Normal or decreased 
• JVP increased
• Hepatomegaly
• Thrill present at apex on palpation( left ventricular failure, turbulence)
• Hyperdynamic character at apex
• Displacement of apex beat 

Diagnosis of Mitral Regurgitation: 

Your cardiologist will employ echocardiography and other cardiovascular imaging procedures to identify mitral valve regurgitation.

1. ECG - P Mitrale: >120 msec (current will take more time, enlarged left atrium)
2. Chest X Ray- Left Atrium enlargement leads to pushing of right atria leading to double atrial shadow/contour. Cardiothoracic ratio increased leading to cardiomegaly (>0.5- adults, >0.6- children). Walking man sign on lateral view (Enlarged left atrium causing enlargement of carinal angle)
3. Transthoracic Echocardiography: Regurgitant jet going from left ventricle to left atrium

Progression of mitral regurgitation:

Heart valve illness that progresses over time is mitral valve regurgitation. The amount of blood that is regurgitated or leaked over time can be used to determine how this illness is progressing. A mitral valve regurgitation condition generally gets worse because the valve gradually changes shape as the blood leaks out. Some patients with mitral regurgitation may find a spontaneous improvement, despite the fact that many suffer from a deterioration of their illness and associated symptoms.

By continuing to see your cardiologist for follow-up appointments and echocardiograms as frequently as your doctor prescribes, Normally every six to twelve months depending on the severity of the leak  you can safeguard your heart health.

Treatment of mitral regurgitation:

Your cardiologist might suggest regular monitoring if your mitral regurgitation is not causing symptoms. Medications may provide comfort if symptoms are present.

Treatment of Acute Mitral Regurgitation          

• It causes acute decompensated heart failure, which contributes to pulmonary edema so Furosemide is used which is diuretic and helps in improving the edema.
• Sodium Nitroprusside - it is used in acute onset sudden decompensation that leads to Left Ventricular Failure to prevent sudden stress on the heart.

Treatment of Chronic Mitral Regurgitation   

In severe variety: 

• Mitral valve repair (MVRp) is done 
• New technique is Mitra clip: Applied with transcatheter approach
• Mitral valve repair is better than mitral valve replacement, as replacement requires lifelong antiplatelet therapy, which can precipitate warfarin toxicity)
• These patients will have atrial fibrillation (due to structural damage)
• Warfarin is used 
• Majority of cases of rheumatic heart disease will have mitral regurgitation, especially children. Novel oral anticoagulants (NOAC) are contraindicated with rheumatic etiology.

Complications of mitral regurgitation:

insufficient forward blood flow is maintained when your mitral valve leaks, preventing the body from functioning as it should. This implies that in order to pump enough blood through the valve, your heart must exert more effort. Subsequent cardiac issues are more likely to develop the harder your heart has to work to make up for this loss. Atrial fibrillation (AFib), heart failure, and pulmonary hypertension can develop as a result of untreated mitral valve regurgitation.

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