Vasodilator therapy in chronic mitral regurgitation
- 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
Patients with severe mitral regurgitation (MR), especially those with heart failure, may experience a dramatic hemodynamic improvement during intravenous vasodilator therapy . Based in part upon these observations, it would seem reasonable to consider the use of oral vasodilators in selected patients with chronic MR.
Candidates for such therapy could include certain patients who are not candidates for surgery, particularly those with end-stage decompensated MR, and those with compensated MR in whom surgery is not yet indicated. In the latter group, the goal of vasodilator therapy might be to reduce the rate of progression of the hemodynamic burden and, therefore, to delay the onset of symptoms and the need for corrective surgery.
An overview of the management of chronic MR is presented separately. (See "Management of chronic primary mitral regurgitation".)
DETERMINANTS OF REGURGITANT VOLUME
The volume of mitral regurgitant volume (MRV) is determined hydraulically by two factors:
●The duration (D) and magnitude of the systolic pressure gradient across the valve; the latter is determined by the difference between the left ventricular and left atrial systolic pressures (LVP and LAP). It can be especially important to consider the duration factor in the evaluation of patients with mitral valve prolapse .
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