Mitral regurgitation stages: Difference between revisions
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|A | |'''A''' | ||
|At risk of [[MR]] | |At risk of [[MR]] | ||
|❑ Mild MVP, normal coaptation<br>❑ Mild valve thickening with leaflet restriction | |❑ Mild MVP, normal coaptation<br>❑ Mild valve thickening with leaflet restriction | ||
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|- | |- | ||
|B | |'''B''' | ||
|Progressive [[MR]] | |Progressive [[MR]] | ||
|❑ Severe MVP, normal coaptation<br>❑ Rheumatic valve changes with leaflet restriction,<br> loss of central coaptation<br>❑Prior IE | |❑ Severe MVP, normal coaptation<br>❑ Rheumatic valve changes with leaflet restriction,<br> loss of central coaptation<br>❑Prior IE | ||
| Line 31: | Line 31: | ||
|None | |None | ||
|- | |- | ||
|C | |'''C''' | ||
|Asymptomatic severe [[MR]] | |Asymptomatic severe [[MR]] | ||
|❑ Severe MVP, flail leaflet<br>❑ Rheumatic valve changes with leaflet restriction,<br> loss of central coaptation<br>❑Prior IE<br> | |❑ Severe MVP, flail leaflet<br>❑ Rheumatic valve changes with leaflet restriction,<br> loss of central coaptation<br>❑Prior IE<br> | ||
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|D||Symptomatic severe [[MR]] | |'''D'''||Symptomatic severe [[MR]] | ||
|❑ Severe MVP, flail leaflet<br>❑ Rheumatic valve changes with leaflet restriction,<br> loss of central coaptation<br>❑Prior IE<br> | |❑ Severe MVP, flail leaflet<br>❑ Rheumatic valve changes with leaflet restriction,<br> loss of central coaptation<br>❑Prior IE<br> | ||
❑ Thickening of leaflets in case of radiation heart disease | ❑ Thickening of leaflets in case of radiation heart disease | ||
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<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> | |||
==References== | |||
{{Reflist|2}} | |||
Revision as of 01:58, 10 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Primary Mitral Regurgitation
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]
| 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 |
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
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.