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| {{SI}}
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| '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S ; [[Lakshmi Gopalakrishnan]], M.B.B.S
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| {{Editor Help}}
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| ==Complications of Mitral Regurgitation==
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| Mitral Regurgitation when mild almost never cause any complications. However, when severe, it may lead to development of:
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| *[[Pulmonary Edema]]
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| *[[Pulmonary Hypertension]]
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| *[[Right Heart Failure]]
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| *[[Atrial Fibrillation]]
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| *[[Thromboembolism]]-[[Stroke]]
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| *[[Endocarditis]]
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| ==Prognosis==
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| *Patients with asymptomatic chronic severe mitral regurgitation have a high likelihood of developing symptoms or LV dysfunction over the course of 6 to 10 years <ref name="pmid8875918">{{cite journal |author=Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL |title=Clinical outcome of mitral regurgitation due to flail leaflet |journal=[[The New England Journal of Medicine]] |volume=335 |issue=19 |pages=1417–23 |year=1996 |month=November |pmid=8875918 |doi=10.1056/NEJM199611073351902 |url=http://dx.doi.org/10.1056/NEJM199611073351902 |accessdate=2011-03-06}}</ref> <ref name="pmid15745978">{{cite journal |author=Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ |title=Quantitative determinants of the outcome of asymptomatic mitral regurgitation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=9 |pages=875–83 |year=2005 |month=March |pmid=15745978 |doi=10.1056/NEJMoa041451 |url=http://dx.doi.org/10.1056/NEJMoa041451 |accessdate=2011-03-06}}</ref> <ref name="pmid16651470">{{cite journal |author=Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H |title=Outcome of watchful waiting in asymptomatic severe mitral regurgitation |journal=[[Circulation]] |volume=113 |issue=18 |pages=2238–44 |year=2006 |month=May |pmid=16651470 |doi=10.1161/CIRCULATIONAHA.105.599175 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16651470 |accessdate=2011-03-06}}</ref>. However, the incidence of sudden death in asymptomatic patients with normal LV function varies widely among these studies.
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| *Clinical outcome is poor in patients with severe symptomatic mitral regurgitation with eight year survival rate of 33% without surgical intervention. Heart failure being the common cause with sudden death attributing to ventricular arrhythmia.<ref name="pmid1936025">{{cite journal |author=Delahaye JP, Gare JP, Viguier E, Delahaye F, De Gevigney G, Milon H |title=Natural history of severe mitral regurgitation |journal=[[European Heart Journal]] |volume=12 Suppl B |issue= |pages=5–9 |year=1991 |month=July |pmid=1936025 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=1936025 |accessdate=2011-03-06}}</ref>
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| *In patients with severe mitral regurgitation due to a flail posterior leaflet, 90% of patients are dead or require MV operation at 10years with the mortality rate in patients with severe mitral regurgitation being 6% to 7% per year. However, the risk of death are predominantly in patients with <60% left ventricular ejection fraction or with NYHA functional class III–IV symptoms <ref name="pmid8875918">{{cite journal |author=Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL |title=Clinical outcome of mitral regurgitation due to flail leaflet |journal=[[The New England Journal of Medicine]] |volume=335 |issue=19 |pages=1417–23 |year=1996 |month=November |pmid=8875918 |doi=10.1056/NEJM199611073351902 |url=http://dx.doi.org/10.1056/NEJM199611073351902 |accessdate=2011-03-06}}</ref> <ref name="pmid9918527">{{cite journal |author=Tribouilloy CM, Enriquez-Sarano M, Schaff HV, Orszulak TA, Bailey KR, Tajik AJ, Frye RL |title=Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications |journal=[[Circulation]] |volume=99 |issue=3 |pages=400–5 |year=1999 |month=January |pmid=9918527 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9918527 |accessdate=2011-03-06}}</ref>.
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| *Severe symptoms also predict a poor outcome after mitral valve repair or replacement. Postoperative survival rates in patients with NYHA functional class III–IV symptoms at 5 and 10 years are 73±3% and 48±4%, respectively. While in patients with NYHA functional class I/II symptoms before surgery survival rates at 5 and 10 years are 90±2% and 76±5%, respectively<ref name="pmid9918527">{{cite journal |author=Tribouilloy CM, Enriquez-Sarano M, Schaff HV, Orszulak TA, Bailey KR, Tajik AJ, Frye RL |title=Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications |journal=[[Circulation]] |volume=99 |issue=3 |pages=400–5 |year=1999 |month=January |pmid=9918527 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9918527 |accessdate=2011-03-06}}</ref>.
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| *In a long-term retrospective study <ref name="pmid15745978">{{cite journal |author=Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ |title=Quantitative determinants of the outcome of asymptomatic mitral regurgitation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=9 |pages=875–83 |year=2005 |month=March |pmid=15745978 |doi=10.1056/NEJMoa041451 |url=http://dx.doi.org/10.1056/NEJMoa041451 |accessdate=2011-03-06}}</ref>, 198 patients with an effective orifice area >40 mm² had a risk of cardiac death at 4% per year during a mean follow-up period of 2.7 years. However, in the another study where 132 patients were followed up prospectively for 5 years, indications for surgery were development of symptoms, LV dysfunction (EF <60%), LV dilatation (LV end-systolic diameter >45 mm), atrial fibrillation, or pulmonary hypertension and there was only 1 cardiac death in an asymptomatic patient, but this patient had refused surgery though it was indicated by development of LV dilation <ref name="pmid16651470">{{cite journal |author=Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H |title=Outcome of watchful waiting in asymptomatic severe mitral regurgitation |journal=[[Circulation]] |volume=113 |issue=18 |pages=2238–44 |year=2006 |month=May |pmid=16651470 |doi=10.1161/CIRCULATIONAHA.105.599175 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16651470 |accessdate=2011-03-06}}</ref>. This suggests good prognosis with valve surgery.
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| *In 80% of patients with atrial fibrillation greater than or equal to 3months duration during preoperative period had persistence of atrial fibrillation after surgery. Hence, mitral valve repair should be done before or soon after the onset of atrial fibrillation to maximize the chance of postoperative sinus rhythm and avoid long-term anticoagulation with warfarin <ref name="pmid8302059">{{cite journal |author=Chua YL, Schaff HV, Orszulak TA, Morris JJ |title=Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty? |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=107 |issue=2 |pages=408–15 |year=1994 |month=February |pmid=8302059 |doi= |url= |accessdate=2011-03-06}}</ref>.
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| ==References==
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| {{reflist|2}}
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| [[Category:cardiology]]
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| {{WH}}
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| {{WS}}
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