Mitral regurgitation follow up

Resident Survival Guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Regular follow up is recommended among patients with asymptomatic mitral regurgitation (MR) and preserved left ventricular ejection fraction.

Follow Up

Echocardiography is performed for follow up among asymptomatic patients with MR to assess the left ventricular ejection fraction (LVEF) and end-systolic dimension. The frequency of follow up with an echocardiogram among asymptomatic patients with MR and normal LVEF is as follows:

• Mild MR: Every 3-5 years
• Moderate MR: Every 1-2 years
• Severe MR: Every 6-12 months (the frequency increases if the the LV dilatation increases)

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Recommendations for Diagnostic Testing: Initial Diagnosis of Chronic MR Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class I

1.   In patients with known or suspected primary MR, TTE is indicated for baseline evaluation of LV size and function, RV function, LA size, pulmonary artery pressure, and the mechanism and severity of primary MR (Stages A to D).(Level of Evidence: B-NR) 2.   In patients with primary MR, when TTE provides insufficient or discordant information, TEE is indicated for evaluation of the severity of MR, mechanism of MR, and status of LV function (Stages B to D).(Level of Evidence: C-EO) 3.   In patients with primary MR, CMR is indicated to assess LV and RV volumes and function and may help with assessing MR severity when there is a discrepancy between the findings on clinical assessment and echocardiography.(Level of Evidence: B-NR) 4.   In patients with severe primary MR undergoing mitral intervention, intraoperative TEE is indicated to establish the anatomic basis for primary MR (Stages C and D) and to guide repair.(Level of Evidence: B-NR)