Natural history of chronic mitral regurgitation caused by mitral valve prolapse and flail mitral leaflet
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
- Section Editors
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- James Hoekstra, MD
James Hoekstra, MD
- Section Editor — Adult Cardiology Emergencies
- Professor and Fredrick Glass Chair
- Wake Forest University
An understanding of the natural history of chronic mitral regurgitation (MR) is an essential part of any medical or surgical management plan. The natural history is variable, depending upon the etiology and the stage at which the disease is first diagnosed.
The major causes of MR are primary diseases of the valve apparatus and secondary (functional) MR due to cardiomyopathy or coronary disease. The causes of primary MR include mitral valve prolapse (MVP), rheumatic heart disease, infective endocarditis, and trauma, which can lead to a flail (or partial flail) mitral leaflet. (See "Clinical manifestations and diagnosis of chronic mitral regurgitation", section on 'Etiology' and "Management and prognosis of chronic secondary mitral regurgitation".)
The best natural history data that are presently available have come from studies of patients with MVP and flail mitral leaflet, which is usually a consequence of degenerative mitral valve disease (eg, MVP). These findings may not apply to MR of other causes, especially ischemic and functional MR.
This topic will review the natural history of chronic primary MR caused by MVP and of flail mitral leaflet. The indications for surgery in chronic MR are discussed separately. (See "Indications for intervention for severe chronic primary mitral regurgitation".)
NATURAL HISTORY OF MITRAL VALVE PROLAPSE
Overview — The estimated prevalence of mitral valve prolapse (MVP) using modern echocardiographic techniques is 0.6 to 2.4 percent [1,2]. The natural history of MVP is generally benign, but serious complications do occur; the most common are infective endocarditis, cerebrovascular accidents, the need for mitral valve surgery, and death. (See "Nonarrhythmic complications of mitral valve prolapse" and "Arrhythmic complications of mitral valve prolapse".)
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