Mitral Regurgitation

Question 1

Most accurate invasive methods of mitral regurgitation assessment

Answer 1

Left ventriculography

Question 2

_______________ and _____________ characterized by a regurgitant volume that overwhelms LA compliance.

This leads to a ____________ wave followed by a ___________ descent on the PCWP tracing.

The ________________ is larger than the LVEDP

Answer 2

Acute Severe MR
Chronic Compensated MR

LARGE V wave
Deep Y descent

Mean PCWP

Question 3

Difference between acute severe MR vs chronic compensated MR in terms of LA V wave

Answer 3

Acute severe MR - LARGE V wave; elevated LA pressure and mean PCWP

Chronic compensated MR - small or large V wave; normal LA pressure and PCWP

Question 4

Hemodynamic findings in decompensated MR in LA tracing

Answer 4

Large V
Deep Y
Shallow X

Question 5

Hemodynamic findings seen in

1. Acute Severe MR
2. Chronic Compensated MR
3. Decompensated Severe MR

Answer 5

1. Acute Severe MR
   -normal LA and LV size
   -increase LA pressure
   -increase EF
   -decrease ESV
   -increase TSV, decrease FSV
2. Chronic Compensated MR
   -eccentric LVH
   -dilated, compliant LA
   -normal LA pressure
   -increase EF
   -increase EDV, decrease ESV
   -increase TSV and FSV
3. Decompensated MR
   -eccentric LVH
   -dilated LA
   -increase LA pressure
   decrease EF
   -increase EDV, increase ESV, decrease SV
   -decrease TSV and FSV
   -increase LVEDP

Question 6

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-

Answer 6

Factors that increase the severity of MR > increase in regurgitant volume, V wave, PCWP, PA pressure
-Exercise (INC Preload)
-Volume loading (INC Preload)
-Hypertension/inc BP (INC afterload)
-Handgrip (INC afterload)

Factors that decrease the severity of MR:
-Vasodilators - nitroprusside (DEC afterload)
-Dec BP (DEC afterload)

Question 7

__________________ are related to distorted LV geometry and increased LV sphericity

Symptomatic patients with an ischemic or a functional mild or moderate MR at rest may have dynamic MR that worsens with ______________ that further tether the valve.

Answer 7

Ischemic or functional MR
Exercise

Symptomatic patients with an ischemic or a functional mild or moderate MR at rest may have dynamic MR that worsens with exercise, that is, with increased venous return and LV volume that further tether the valve.

It may explain exertional or nocturnal symptoms and pulmonary edema in patients with mild ischemic MR. In this case, PCWP, V wave, and PA pressure increase during exercise or during sleep with the increase in venous return.

Question 8

Class 1 indications for intervention in Primary MR

Answer 8

In symptomatic patients with severe primary MR (Stage D), mitral valve intervention is recommended irrespective of LV systolic function

In asymptomatic patients with severe primary MR and LV systolic dysfunction (LVEF ≤60%, LVESD ≥40 mm) (Stage C2), mitral valve surgery is recommended

In patients with severe primary MR for whom surgery is indicated, mitral valve repair is recommended in preference to mitral valve replacement when the anatomic cause of MR is degenerative disease, if a successful and durable repair is possible.