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Furthermore, the prevalence of mitral regurgitation increases with age 1. Presentation is dependent on whether the mitral valve disease represents acute or chronic regurgitation 1,2. In chronic mitral regurgitation, there may be relative compensation with limited signs and symptoms 1,2. The murmur may radiate to to the left axilla in posterior leaflet disease or to the back in anterior leaflet disease 1,2.
Patients with chronic mitral regurgitation, in the initial stages of the disease, compensate with more complete left ventricular emptying, resulting in a supraphysiological ejection fraction 1,2. In order to maintain sufficient forward cardiac output, this compensatory mechanism is met with an increased diastolic volume 1,2. This, over time, results in increased compliance of the walls of the left atrium and ventricle as they respond to volume overload in both chambers 1,2.
In particular, left atrial enlargement can be responsible for development of arrhythmias and symptoms of atrial mass-effect on adjacent structures 1,2. Eventually this mechanism fails, and the left ventricle can not compensate for the volume overload 1,2. This causes the stroke volume to decrease and the cardiac output to decrease 1,2. This volume overload eventually causes a drop in forward cardiac output 1,2. It is at this point where the ejection fraction may fall, signifying severe mitral regurgitation 1,2.
In contrast, in acute mitral regurgitation, sudden regurgitant volume enters into a relatively normal left atrium that does not have years to develop the compliance seen in chronic mitral regurgitation 1,2. This results in a sudden increase in left atrial pressure and pulmonary venous pressures 1,2. Thus, acute pulmonary edema is a common manifestation in acute mitral regurgitation. Thus, the causes of mitral regurgitation are protean and, as such, there is no single group of patients who are affected 1,2.
Mitral regurgitation can be divided into acute and chronic forms, which have differing etiologies and imaging features 1,2. Furthermore, causes and mechanisms can be divided into primary causes i.
In acute mitral regurgitation, radiographic signs of left atrial enlargement are often absent 5. Various parameters are used in order to determine severity, such as 6 :. Cross-sectional imaging is rarely used to evaluate mitral regurgitation, however demonstrate the same radiographic features appreciated on plain film and echocardiography, but in greater detail 1, 7.
In particular, cardiac MRI CMR may be particularly useful for accurate measurements pertaining to the valve, regurgitant volume, and underlying etiology 1,7. If mitral regurgitation is acute and secondary to papillary rupture, the treatment of choice is mitral valve replacement 8.
If there is concurrent hypotension i. In chronic mitral regurgitation, vasodilators are used to decrease afterload, e. ACE inhibitors The main radiographic differential is that of mitral stenosis which also leads to enlargement of the left atrium.
Unlike mitral regurgitation, mitral stenosis does not have left ventricular enlargement and usually has less striking enlargement of the left atrium 2. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait. Unable to process the form. Check for errors and try again. Thank you for updating your details. Log In. Sign Up. Log in Sign up.
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On this page:. Mitral regurgitation. Fauci AS. Harrison's principles of internal medicine. Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe.
Woolley K, Stark P. Pulmonary parenchymal manifestations of mitral valve disease. Radiographics full text - Pubmed citation 5.
Brant WE, Helms C. Fundamentals of Diagnostic Radiology. Read it at Google Books - Find it at Amazon 6. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. Michael F. Morris, Joseph J. Maleszewski, Rakesh M. Suri, Harold M. Burkhart, Thomas A. Foley, Crystal R. Bonnichsen, Nandan S.
Anavekar, Phillip M. Young, Eric E. Williamson, James F. Glockner, Philip A. Hoit BD. Medical treatment of valvular heart disease. Pubmed citation Percutaneous repair or surgery for mitral regurgitation. Promoted articles advertising. Edit article Share article View revision history Report problem with Article. URL of Article. Article information. System: Cardiac. Tag: cardiology. Synonyms or Alternate Spellings: Mitral regurgitation Mitral valve insufficiency Mitral valve incompetence Mitral insufficiency Mitral incompetence.
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Furthermore, the prevalence of mitral regurgitation increases with age 1. Presentation is dependent on whether the mitral valve disease represents acute or chronic regurgitation 1,2. In chronic mitral regurgitation, there may be relative compensation with limited signs and symptoms 1,2. The murmur may radiate to to the left axilla in posterior leaflet disease or to the back in anterior leaflet disease 1,2. Patients with chronic mitral regurgitation, in the initial stages of the disease, compensate with more complete left ventricular emptying, resulting in a supraphysiological ejection fraction 1,2.