Mitral Regurgitation Complications and Prognosis: Difference between revisions
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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. | *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. | ||
*In 80% of patients with atrial fibrillation greater than or equal to 3months duration during preoperative period had persistence of atrial fibrillation after surgery <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>. | *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>. | ||
==References== | ==References== | ||
Revision as of 09:11, 6 March 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S ; Lakshmi Gopalakrishnan, M.B.B.S
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Complications of Mitral Regurgitation
Mitral Regurgitation when mild almost never cause any complications. However, when severe, it may lead to development of:
- Pulmonary Edema
- Pulmonary Hypertension
- Right Heart Failure
- Atrial Fibrillation
- Thromboembolism-Stroke
- Endocarditis
Prognosis
- 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 [1] [2] [3]. However, the incidence of sudden death in asymptomatic patients with normal LV function varies widely among these studies.
- 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.[4]
- 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 [1] [5].
- 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[5].
- In a long-term retrospective study [2], 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 [3]. This suggests good prognosis with valve surgery.
- 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 [6].
References
- ↑ 1.0 1.1 Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL (1996). "Clinical outcome of mitral regurgitation due to flail leaflet". The New England Journal of Medicine. 335 (19): 1417–23. doi:10.1056/NEJM199611073351902. PMID 8875918. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ (2005). "Quantitative determinants of the outcome of asymptomatic mitral regurgitation". The New England Journal of Medicine. 352 (9): 875–83. doi:10.1056/NEJMoa041451. PMID 15745978. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H (2006). "Outcome of watchful waiting in asymptomatic severe mitral regurgitation". Circulation. 113 (18): 2238–44. doi:10.1161/CIRCULATIONAHA.105.599175. PMID 16651470. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ Delahaye JP, Gare JP, Viguier E, Delahaye F, De Gevigney G, Milon H (1991). "Natural history of severe mitral regurgitation". European Heart Journal. 12 Suppl B: 5–9. PMID 1936025. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 Tribouilloy CM, Enriquez-Sarano M, Schaff HV, Orszulak TA, Bailey KR, Tajik AJ, Frye RL (1999). "Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications". Circulation. 99 (3): 400–5. PMID 9918527. Retrieved 2011-03-06. Unknown parameter
|month=ignored (help) - ↑ Chua YL, Schaff HV, Orszulak TA, Morris JJ (1994). "Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty?". The Journal of Thoracic and Cardiovascular Surgery. 107 (2): 408–15. PMID 8302059. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help)