Mitral regurgitation stages: Difference between revisions
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==Secondary Mitral Regurgitation Stages== | ==Secondary Mitral Regurgitation Stages== | ||
{|Class="wikitable" | |||
|- | |||
!STAGE | |||
!DEFINITION | |||
!VALVE ANATOMY | |||
!VALVE HEMODYNAMICS | |||
!HEMODYNAMIC CONSEQUENCES | |||
!SYMPTOMS | |||
|- | |||
|'''A''' | |||
|At risk of [[MR]] | |||
|❑ The valve leaflets, chords, and annulus are normal in a patient with CAD or cardiomyopathy | |||
|❑ No [[MR]] jet area or central jet area < 20% LA on doppler<br>❑ Small vena contracta <0.3 cm | |||
| ❑ The LV is normal or mildly dilated and is associated with a fixed or inducible regional wall abnormality <br> | |||
❑ LV dilatation and systolic dysfunction due to a primary myocardial disease| Possible symptoms of CAD or HF that are responsive to treatment or revascularization | |||
|- | |||
|'''B''' | |||
|Progressive [[MR]] | |||
|❑ Mild tethering of the leaflets of the mitral valve with regional wall motion abnormality <br>❑ Annular dilatation and mild loss of coaptation of the mitral leaflets | |||
|❑ Regurgitant volume < 30 ml<br>❑ Regurgitant fraction <50 %<br>❑ ERO <0.20 cm<sup>2</sup><br> | |||
|❑ Regional wall abnormality and LV systolic dysfunction<br> | |||
❑ LV dilatation and systolic dysfunction due to a primary myocardial disease | |||
|Possible symptoms of CAD or HF that are responsive to treatment or revascularization | |||
|- | |||
|'''C''' | |||
|Asymptomatic severe [[MR]] | |||
|❑ Severe tethering of the leaflets of the mitral valve and LV dilatation with/without regional wall motion abnormality <br>❑ Annular dilatation and severe loss of coaptation of the mitral leaflets | |||
|❑ Regurgitant volume ≥30 ml<br>❑ Regurgitant fraction ≥50 %<br>❑ ERO ≥0.20 cm<sup>2</sup><br> | |||
|❑ Regional wall abnormality and LV systolic dysfunction<br> | |||
❑ LV dilatation and systolic dysfunction due to a primary myocardial disease | |||
|Possible symptoms of CAD or HF that are responsive to treatment or revascularization | |||
|- | |||
|'''D'''||Symptomatic severe [[MR]] | |||
|❑ Severe tethering of the leaflets of the mitral valve and LV dilatation with/without regional wall motion abnormality <br>❑ Annular dilatation and severe loss of coaptation of the mitral leaflets | |||
|❑ Regurgitant volume ≥30 ml<br>❑ Regurgitant fraction ≥50 %<br>❑ ERO ≥0.20 cm<sup>2</sup><br> | |||
|❑ Regional wall abnormality and LV systolic dysfunction<br> | |||
❑ LV dilatation and systolic dysfunction due to a primary myocardial disease | |||
|Symptoms of CAD or HF that are non responsive to treatment or revascularization <br>❑ Decreased exercise tolerance<br>❑ [[Exertional dyspnea]] | |||
|- | |||
|} | |||
==References== | ==References== |
Revision as of 20:54, 5 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
Primary Mitral Regurgitation Stages
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 and leaflet restriction |
❑ No MR jet area or central jet area < 20% LA on doppler ❑ Small vena contracta <0.3 cm |
Absent | Absent |
B | Progressive MR | ❑ Severe MVP, normal coaptation ❑ Rheumatic valve changes with leaflet restriction and loss of central coaptation due to ❑ Previous infective endocarditis |
❑ 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 ❑ Absent LV enlargement ❑ Normal pulmonary pressure |
Absent |
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 |
Absent |
D | Symptomatic severe MR | ❑ Severe MVP, flail leaflet ❑ Rheumatic valve changes with leaflet restriction, loss of central coaptation ❑ Previous infective endocarditis ❑ 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 |
Secondary Mitral Regurgitation Stages
STAGE | DEFINITION | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES | SYMPTOMS |
---|---|---|---|---|---|
A | At risk of MR | ❑ The valve leaflets, chords, and annulus are normal in a patient with CAD or cardiomyopathy | ❑ No MR jet area or central jet area < 20% LA on doppler ❑ Small vena contracta <0.3 cm |
❑ The LV is normal or mildly dilated and is associated with a fixed or inducible regional wall abnormality ❑ LV dilatation and systolic dysfunction due to a primary myocardial disease| Possible symptoms of CAD or HF that are responsive to treatment or revascularization | |
B | Progressive MR | ❑ Mild tethering of the leaflets of the mitral valve with regional wall motion abnormality ❑ Annular dilatation and mild loss of coaptation of the mitral leaflets |
❑ Regurgitant volume < 30 ml ❑ Regurgitant fraction <50 % ❑ ERO <0.20 cm2 |
❑ Regional wall abnormality and LV systolic dysfunction ❑ LV dilatation and systolic dysfunction due to a primary myocardial disease |
Possible symptoms of CAD or HF that are responsive to treatment or revascularization |
C | Asymptomatic severe MR | ❑ Severe tethering of the leaflets of the mitral valve and LV dilatation with/without regional wall motion abnormality ❑ Annular dilatation and severe loss of coaptation of the mitral leaflets |
❑ Regurgitant volume ≥30 ml ❑ Regurgitant fraction ≥50 % ❑ ERO ≥0.20 cm2 |
❑ Regional wall abnormality and LV systolic dysfunction ❑ LV dilatation and systolic dysfunction due to a primary myocardial disease |
Possible symptoms of CAD or HF that are responsive to treatment or revascularization |
D | Symptomatic severe MR | ❑ Severe tethering of the leaflets of the mitral valve and LV dilatation with/without regional wall motion abnormality ❑ Annular dilatation and severe loss of coaptation of the mitral leaflets |
❑ Regurgitant volume ≥30 ml ❑ Regurgitant fraction ≥50 % ❑ ERO ≥0.20 cm2 |
❑ Regional wall abnormality and LV systolic dysfunction ❑ LV dilatation and systolic dysfunction due to a primary myocardial disease |
Symptoms of CAD or HF that are non responsive to treatment or revascularization ❑ Decreased exercise tolerance ❑ Exertional dyspnea |
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.