Chronic mitral regurgitation treatment: Difference between revisions
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There are two surgical options for the treatment of mitral regurgitation: [[mitral valve replacement]] and [[mitral valve repair]] | There are two surgical options for the treatment of mitral regurgitation: [[mitral valve replacement]] and [[mitral valve repair]] | ||
==ACC/AHA Guidelines- Indications for Surgery for Mitral Regurgitation (DO NOT EDIT) <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc=| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134 }} </ref>== | |||
{{cquote| | {{cquote| | ||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | |||
'''1.''' MV surgery is recommended for the symptomatic patient with acute severe MR. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) | |||
1. MV | |||
severe MR | |||
'''2.''' MV surgery is beneficial for patients with chronic severe MR and NYHA functional class II, III, or IV symptoms in the absence of severe LV dysfunction (severe LV dysfunction is defined as ejection fraction less than 0.30) and/or end-systolic dimension greater than 55 mm. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) | |||
MR, | |||
'''3.''' MV surgery is beneficial for asymptomatic patients with chronic severe MR and mild to moderate LV dysfunction, ejection fraction 0.30 to 0.60, and/or end-systolic dimension greater than or equal to 40 mm. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) | |||
or end-systolic dimension greater than | |||
(Level of Evidence: | |||
====Class IIb=== | '''4.''' MV repair is recommended over MV replacement in the majority of patients with severe chronic MR who require surgery, and patients should be referred to surgical centers experienced in MV repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | ||
1. MV repair may be considered for patients with | |||
chronic severe secondary MR due to severe LV | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | ||
dysfunction ( | |||
NYHA functional class | '''1.''' MV repair is reasonable in experienced surgical centers for asymptomatic patients with chronic severe MR with preserved LV function (ejection fraction greater than 0.60 and end-systolic dimension less than 40 mm) in whom the likelihood of successful repair without residual MR is greater than 90%. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) | ||
optimal therapy for heart failure, including | |||
biventricular pacing. (Level of Evidence: C) | '''2.''' MV surgery is reasonable for asymptomatic patients with chronic severe MR, preserved LV function, and new onset of atrial fibrillation. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | ||
'''3.''' MV surgery is reasonable for asymptomatic patients with chronic severe MR, preserved LV function, and pulmonary hypertension (pulmonary artery systolic pressure greater than 50 mm Hg at rest or greater than 60 mm Hg with exercise). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
'''4.''' MV surgery is reasonable for patients with chronic severe MR due to a primary abnormality of the mitral apparatus and NYHA functional class III–IV symptoms and severe LV dysfunction (ejection fraction less than 0.30 and/or end-systolic dimension greater than 55 mm) in whom MV repair is highly likely. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | |||
'''1.''' MV repair may be considered for patients with chronic severe secondary MR due to severe LV dysfunction (ejection fraction less than 0.30) who have persistent NYHA functional class III–IV symptoms despite optimal therapy for heart failure, including biventricular pacing. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]=== | |||
'''1.''' MV surgery is not indicated for asymptomatic patients with MR and preserved LV function (ejection fraction greater than 0.60 and end-systolic dimension less than 40 mm) in whom significant doubt about the feasibility of repair exists. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
'''2.''' Isolated MV surgery is not indicated for patients with mild or moderate MR. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])}} | |||
==References== | ==References== | ||
Revision as of 15:59, 26 September 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.
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Vasodilator therapy is a mainstay in the management of chronic mitral regurgitation. In the chronic state, the most commonly used agents are ACE inhibitors and hydralazine. Studies have shown that the use of ACE inhibitors and hydralazine can delay surgical treatment of mitral regurgitation[1] [2]. The current guidelines for treatment of mitral regurgitation limit the use of vasodilators to individuals with hypertension
There are two surgical options for the treatment of mitral regurgitation: mitral valve replacement and mitral valve repair
ACC/AHA Guidelines- Indications for Surgery for Mitral Regurgitation (DO NOT EDIT) [3]
| “ |
Class I1. MV surgery is recommended for the symptomatic patient with acute severe MR. (Level of Evidence: B) 2. MV surgery is beneficial for patients with chronic severe MR and NYHA functional class II, III, or IV symptoms in the absence of severe LV dysfunction (severe LV dysfunction is defined as ejection fraction less than 0.30) and/or end-systolic dimension greater than 55 mm. (Level of Evidence: B) 3. MV surgery is beneficial for asymptomatic patients with chronic severe MR and mild to moderate LV dysfunction, ejection fraction 0.30 to 0.60, and/or end-systolic dimension greater than or equal to 40 mm. (Level of Evidence: B) 4. MV repair is recommended over MV replacement in the majority of patients with severe chronic MR who require surgery, and patients should be referred to surgical centers experienced in MV repair. (Level of Evidence: C) Class IIa1. MV repair is reasonable in experienced surgical centers for asymptomatic patients with chronic severe MR with preserved LV function (ejection fraction greater than 0.60 and end-systolic dimension less than 40 mm) in whom the likelihood of successful repair without residual MR is greater than 90%. (Level of Evidence: B) 2. MV surgery is reasonable for asymptomatic patients with chronic severe MR, preserved LV function, and new onset of atrial fibrillation. (Level of Evidence: C) 3. MV surgery is reasonable for asymptomatic patients with chronic severe MR, preserved LV function, and pulmonary hypertension (pulmonary artery systolic pressure greater than 50 mm Hg at rest or greater than 60 mm Hg with exercise). (Level of Evidence: C) 4. MV surgery is reasonable for patients with chronic severe MR due to a primary abnormality of the mitral apparatus and NYHA functional class III–IV symptoms and severe LV dysfunction (ejection fraction less than 0.30 and/or end-systolic dimension greater than 55 mm) in whom MV repair is highly likely. (Level of Evidence: C) Class IIb1. MV repair may be considered for patients with chronic severe secondary MR due to severe LV dysfunction (ejection fraction less than 0.30) who have persistent NYHA functional class III–IV symptoms despite optimal therapy for heart failure, including biventricular pacing. (Level of Evidence: C) Class III1. MV surgery is not indicated for asymptomatic patients with MR and preserved LV function (ejection fraction greater than 0.60 and end-systolic dimension less than 40 mm) in whom significant doubt about the feasibility of repair exists. (Level of Evidence: C) 2. Isolated MV surgery is not indicated for patients with mild or moderate MR. (Level of Evidence: C) |
” |
References
- ↑ Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K (1978). "Beneficial effects of hydralazine in severe mitral regurgitation". Circulation. 58 (2): 273–9. PMID 668075. Retrieved 2011-03-16. Unknown parameter
|month=ignored (help) - ↑ Hoit BD (1991). "Medical treatment of valvular heart disease". Current Opinion in Cardiology. 6 (2): 207–11. PMID 10149580. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134.