eMedicine Specialties > Cardiology > Valvular Heart Disease

Mitral Regurgitation: Follow-up

Author: Ivan Hanson, MD, Chief Medical Resident, Department of Internal Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine
Coauthor(s): Luis C Afonso, MD, Assistant Professor, Department of Internal Medicine-Cardiology, Program Director of Cardiology Fellowship Program, Wayne State University; Director of Echocardiography Laboratory, Harper University Hospital
Contributor Information and Disclosures

Updated: Oct 29, 2009

Follow-up

Complications

  • Medical complications
    • Pulmonary edema
    • Congestive heart failure
    • Irreversible LV systolic dysfunction
    • Thromboembolism resulting from atrial fibrillation 
  • Surgical complications
    • Operative risks include infection, bleeding, intraoperative myocardial infarction, and stroke.
    • In young patients, bioprosthetic valves (ie, porcine valves) have a propensity for early degeneration due to calcification.
    • Mechanical valve complications include prosthetic valve dysfunction and valve thrombosis with or without embolism, particularly in the patient who is not adequately anticoagulated. 
    • Hemolysis may occur in the patient with a ball and cage mechanical valve because of mechanical valve destruction of circulating red blood cells. Hemolysis in the patient with a tilting disk valve usually indicates the presence of a perivalvular leak.
    • Thromboembolism in patients with mechanical valves who are on anticoagulation therapy occurs at a rate of 1-3% per year. 
    • In the absence of anticoagulation, thromboembolism occurs at a rate of approximately 1.5% per year with a porcine valve.
    • Prosthetic valve infection may occur in bioprosthetic or mechanical valves.

Prognosis

  • Asymptomatic chronic severe degenerative MR
    • Mortality ranges from 50-73% at 5 years.
    • Mortality in patients with preserved LV function ranges from 27-45%.
    • Sudden death may be as common as 1-8% per year in patients with a flail leaflet.
  • Mitral valve surgery operative mortality
    • Isolated mitral valve repair surgery carries a 2% mortality.
    • Mitral valve replacement surgery
      • 4% mortality for patients younger than 50 years.
      • 17% mortality for patients older than 80 years.

Patient Education

For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Mitral Valve Prolapse.

Miscellaneous

Medicolegal Pitfalls

  • Failure to institute appropriate echocardiographic testing before irreversible damage occurs
  • Failure to obtain consultations with specialists in cardiology and cardiothoracic surgery early during patient stabilization
  • Failure to institute proper antibiotic prophylaxis before an interventional treatment
  • Failure to exclude myocardial infarction in patients experiencing an exacerbation of chronic mitral valve regurgitation with hemodynamic compromise
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Shivkumar H Jha, MD; Jatin Dave, MD, MPH; Kishorkumar Desai, MD; and Abraham G Kocheril, MD, FACC, FACP to the development and writing of this article.



More on Mitral Regurgitation

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Differential Diagnoses & Workup: Mitral Regurgitation
Treatment & Medication: Mitral Regurgitation
Follow-up: Mitral Regurgitation
Multimedia: Mitral Regurgitation
References
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References

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Further Reading

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Keywords

mitral regurgitation, MR, mitral incompetence, mitral insufficiency, myxomatous degeneration, ruptured chordae tendineae, collagen-vascular disease, collagen vascular disease, rheumatic fever, myxomatous mitral valve, Down syndrome, Down's syndrome, acute mitral valve regurgitation, mitral valve regurgitation, mitral valve incompetence, mitral valve insufficiency, cardiogenic shock, mitral valve disease, mitral valvular abnormality, prosthetic valve failure, perforated mitral valve leaflet, perforated mitral valve, mitral valve prolapse, MVP, rheumatic heart disease, coronary artery disease, CAD, annular calcification, connective tissue disorder, connective-tissue disorder, left ventricle dilation, left ventricle dilatation, LV dilation, LV dilatation, prosthetic heart valve, cardiac valvular lesion, functional ischemic mitral regurgitation

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Contributor Information and Disclosures

Author

Ivan Hanson, MD, Chief Medical Resident, Department of Internal Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine
Ivan Hanson, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Michigan State Medical Society, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Luis C Afonso, MD, Assistant Professor, Department of Internal Medicine-Cardiology, Program Director of Cardiology Fellowship Program, Wayne State University; Director of Echocardiography Laboratory, Harper University Hospital
Luis C Afonso, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and American Society of Echocardiography
Disclosure: Nothing to disclose.

Medical Editor

Martin Keane, MD, FACC, FAHA, Associate Professor, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania School of Medicine
Martin Keane, MD, FACC, FAHA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Society of Echocardiography, Pennsylvania Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald J Oudiz, MD, FACP, FACC, Associate Professor of Medicine, Division of Cardiology, The David Geffen School of Medicine at UCLA; Director, Liu Center for Pulmonary Hypertension, LA Biomedical Research Institute at Harbor-UCLA Medical Center
Ronald J Oudiz, MD, FACP, FACC is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx  Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, Professor and Executive Vice Chairman, Department of Medicine, University of Texas Health Science Center at San Antonio
Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors
Disclosure: Nothing to disclose.

 
 
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