Mitral regurgitation stages: Difference between revisions
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== | ==Overview== | ||
==Stages of Primary Mitral Regurgitation== | |||
Shown below is the able depicting stages of mitral regurgitation, adapted from 2014 AHA/ACC guidelines for management of valvular heart disease.<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref> | Shown below is the able depicting stages of mitral regurgitation, adapted from 2014 AHA/ACC guidelines for management of valvular heart disease.<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref> | ||
<span style="font-size:85%">'''MR:''' Mitral regurgitation; '''MVP:''' Mitral valve prolapse; '''IE:''' Infective endocarditis; '''LA:''' Left atrium; '''ERO:''' Effective regurgitant orifice; '''LV:''' Left ventricle; '''LVEF:''' Left ventricular ejection fraction; '''LVESD:''' Left ventricular end systolic dimension </span> | |||
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==Stages of Secondary Mitral Regurgitation== | |||
==References== | ==References== |
Revision as of 02:26, 3 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Overview
Stages of Primary Mitral Regurgitation
Shown below is the able depicting stages of mitral regurgitation, adapted from 2014 AHA/ACC guidelines for management of valvular heart disease.[1]
MR: Mitral regurgitation; MVP: Mitral valve prolapse; IE: Infective endocarditis; LA: Left atrium; ERO: Effective regurgitant orifice; LV: Left ventricle; LVEF: Left ventricular ejection fraction; LVESD: Left ventricular end systolic dimension
STAGE | DEFINITION | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES | SYMPTOMS |
---|---|---|---|---|---|
A | At risk of MR | ❑ Mild MVP, normal coaptation ❑ Mild valve thickening with leaflet restriction |
❑ No MR jet area OR ❑ Central jet area < 20% LA on doppler ❑ Small vena contracta <0.3 cm |
None | None |
B | Progressive MR | ❑ Severe MVP, normal coaptation ❑ Rheumatic valve changes with leaflet restriction, loss of central coaptation ❑ Prior IE |
❑ Central jet area 20-40% LA OR late systolic eccentric jet MR ❑ Vena contracta < 0.7 cm ❑ Regurgitant volume < 60 ml ❑ Regurgitant fraction <50 % ❑ ERO <0.40 cm2 ❑ Angiographic grade 1 - 2+ |
❑ Mild LA enlargement ❑ No LV enlargement ❑ Normal pulmonary pressure |
None |
C | Asymptomatic severe MR | ❑ Severe MVP, flail leaflet ❑ Rheumatic valve changes with leaflet restriction, loss of central coaptation ❑ Prior IE ❑ Thickening of leaflets in case of radiation heart disease |
❑ Central jet area > 40% LA OR holosystolic eccentric jet MR ❑ Vena contracta ≥ 0.7 cm ❑ Regurgitant volume ≥ 60 ml ❑ Regurgitant fraction ≥50 % ❑ ERO ≥0.40 cm2 ❑ Angiographic grade 3 - 4+ |
❑ Moderate to severe LA enlargement ❑ LV enlargement ❑Pulmonary hypertension present at rest or with exercise ❑ C1: LVEF > 60% and LVESD < 40 mm ❑ C2: LVEF ≤ 60 % and LVESD ≥ 40 mm |
None |
D | Symptomatic severe MR | ❑ Severe MVP, flail leaflet ❑ Rheumatic valve changes with leaflet restriction, loss of central coaptation ❑ Prior IE ❑ Thickening of leaflets in case of radiation heart disease |
❑ Central jet area >40% LA OR holosystolic eccentric jet MR ❑ Vena contracta ≥ 0.7 cm ❑ Regurgitant volume ≥ 60 ml ❑ Regurgitant fraction ≥ 50 % ❑ ERO ≥0.40 cm2 ❑ Angiographic grade 3 - 4+ |
❑ Moderate to severe LA enlargement ❑ LV enlargement ❑Pulmonary hypertension present |
❑ Decreased exercise tolerance ❑ Exertional dyspnea |
Stages of Secondary Mitral Regurgitation
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.