Mitral Regurgitation Follow-up

Updated: Jan 03, 2016
  • Author: Ivan Hanson, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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Follow-up

Complications

Medical complications may include the following:

  • Pulmonary edema
  • Congestive heart failure
  • Irreversible LV systolic dysfunction
  • Thromboembolism resulting from atrial fibrillation

Surgical complications may include the following:

  • 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.
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Prognosis

Outcomes for asymptomatic chronic severe degenerative MR are as follows:

  • 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.

In a study of patients with low EF (regardless of ischemic or nonischemic etiology), the presence of functional MR  is associated with a 2-fold greater risk of all-cause mortality and hospitalization at 1-5 years. [16]

Mitral valve surgery operative mortality includes the following:

  • 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.

Tribouilloy et al found that, in patients with organic MR  due to flail leaflets, left ventricular end-systolic diameter (LVESD) is independently associated with increased mortality. Analysis of results in 739 patients showed that LVESD ≥ 40 mm independently predicted overall mortality (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.01-3.83) and cardiac mortality (HR 3.09; 95% CI, 1.35-7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR 1.15; 95% CI, 1.04-1.27 per 1-mm increment). Tribouilloy et al conclude that these findings support prompt surgical rescue in patients with LVESD ≥40 mm but also suggest that operating on patients before LVESD reaches 40 mm will best preserve survival. [17]

Magne et al found that exercise pulmonary hypertension can be predicted using resting comprehensive echocardiography in asymptomatic patients with degenerative MR . [18]

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Patient Education

For patient education resources, see Heart Health Center as well as Mitral Valve Prolapse.

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