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Management and prognosis of chronic secondary mitral regurgitation

William H Gaasch, MD
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Management of patients with chronic secondary mitral regurgitation (MR) requires an understanding of the pathophysiology and natural history of the disease and the efficacy and timing of treatment, particularly mitral valve repair and replacement. While our knowledge of these areas is incomplete, a rational plan for management based upon the available evidence is presented here [1,2].

Secondary MR (also known as functional MR) is caused by left ventricular dysfunction caused by coronary heart disease or by a cardiomyopathy. Secondary MR caused by coronary heart disease (generally with myocardial infarction) is known as ischemic MR. In contrast, primary MR is caused by primary abnormality of one or more components of the valve apparatus. Identification of the cause and type (primary or secondary) of MR is required for appropriate management of MR and associated conditions.

The pathophysiology, diagnosis, and evaluation of chronic MR, the management of chronic primary MR, and the management of acute MR are presented elsewhere. (See "Pathophysiology of chronic mitral regurgitation" and "Clinical manifestations and diagnosis of chronic mitral regurgitation" and "Management of chronic primary mitral regurgitation" and "Acute mitral regurgitation in adults" and "Acute mitral regurgitation in adults", section on 'Treatment'.)


Staging of secondary mitral regurgitation (MR) is based upon symptoms, valve anatomy, and valve hemodynamics (severity of MR), which are associated with left ventricular (LV) dysfunction (due to coronary artery disease or cardiomyopathy) as described in the 2014 American Heart Association/American College of Cardiology valvular heart disease guidelines (table 1) [1]:

In stage A, patients are at risk of MR (or have mild MR). Mitral valve leaflets, chords, and annulus are normal with no or mild MR (small central jet <20 percent of left atrium on color Doppler with vena contracta <0.3 cm). Patients with coronary artery disease have normal or mildly dilated LV size with fixed (myocardial infarction) or inducible (ischemia) regional wall motion abnormalities. Patients with cardiomyopathy have abnormal LV geometry, usually with dilation and systolic dysfunction.


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Literature review current through: Sep 2016. | This topic last updated: Apr 21, 2016.
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