Mitral regulation presentation

1. Mitral
regurgitation
By
Dr.Abitha Thabassum.,M.P.T,MIAP

2. Mitral
regurgitatio
n
▪Backflow of blood through a
defective heart valve
▪.Any one or more of the five
functional components of the mitral
valve apparatus-
▪Leaflets, Annulus,Chordae tendineae,
Papillary muscles,Subjacent
myocardium

3. Pictorial
presentatio
n

4. Etiology
1. Acute
▪Endocarditis
▪Papillary muscle rupture (post-MI)
▪Trauma
▪Chordal rupture/leaflet flail

6. Etiology
1. Chronic
▪Myxomatous (MVP)
▪Rheumatic fever
▪Endocarditis (healed)
▪Mitral annular
calcificationCongenital (cleft, AV
canal)
▪Ischemic (LV remodeling)
▪Dilated cardiomyopathy,Radiation

7. Pathophysiolo
gy
▪Regurgitation into the LA produces LA
dilatation
▪But little increase in left atrial pressure if the
regurgitation is chronic- as the regurgitant
flow is accommodated by thelarge left atrium
▪ Acute mitral regurgitation - normal
compliance of the left atrium does not allow
much dilatation- left atrial pressure rises.

9. Symptom
1. Symptom
▪Dyspnoea or Orthopnea
(pulmonary venous congestion)
▪Fatigue (low cardiac output)
▪Palpitation (atrial
fibrillation, increased stroke
volume)
▪Oedema, ascites (right heart failure)

10. Signs
▪ Atrial fibrillation/flutter
▪Cardiomegaly: displaced hyperdynamic apex
beat
▪Apical pansystolic murmur ± thrill
▪Signs of pulmonary venous congestion
(crepitations, pulmonary oedema, effusions)
▪Signs of pulmonary hypertension and right heart
failure
▪Floppy mitral valve - mid-systolic click
▪Prominent third heart sound

11. Investigations
ECG
Left atrial hypertrophy (if not in AF)
▪Left ventricular hypertrophy
▪Chest x-ray- Enlarged LA
▪Enlarged LV- Pulmonary venous
congestion
▪Pulmonary oedema (if acute)

13. Cont…
Echo
▪Dilated LA, LV
▪ Dynamic LV (unless myocardial dysfunction
predominates)
▪Structural abnormalities of mitral valve (e.g.
prolapse)
▪Doppler: Detects and quantifies regurgitation
▪ Cardiac catheterisation- Dilated LA, dilated
LV, mitral regurgitation- Pulmonary
hypertension- Coexisting coronary artery disease

14. Managemen
t
Mild MR
▪Diuretics
▪Vasodilators
▪Digoxin if atrial fibrillation is
present
▪Anticoagulants if atrial fibrillation
is present

15. Cont..
▪Surgery- Valvotomy,
Valvuloplasty and valve
replacement
▪Annuloplasty ring- overcome
annular dilatation- bring the valve
leaflets closer together

16. Thankyou