Mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to leak backward.
It may develop suddenly after myocardial infarction due to papillary muscle rupture, or progress over time as a result of papillary muscle dysfunction and left ventricular remodeling.
What it is
Mitral regurgitation is broadly classified into acute and chronic forms.
Acute mitral regurgitation can occur due to papillary muscle rupture following myocardial infarction and often requires urgent surgical treatment.
Chronic mitral regurgitation, particularly in ischemic heart disease, is associated with papillary muscle dysfunction and changes in left ventricular geometry over time.
Acute papillary muscle rupture
Acute papillary muscle rupture is a life-threatening complication of myocardial infarction.
When the papillary muscle supporting the mitral valve ruptures, severe mitral regurgitation develops abruptly and can lead to rapid hemodynamic collapse.
- Clinical severity ranges from cardiogenic shock to cases that can be temporarily stabilized before emergency surgery.
- The clinical course depends on the severity of regurgitation and the patient’s overall condition.
Symptoms and diagnosis
Patients may present with sudden severe shortness of breath and can rapidly deteriorate to cardiogenic shock.
A new systolic murmur may be an important clinical clue.
Echocardiography is essential for diagnosis and assessment of severity.
Treatment for acute cases
Urgent surgical intervention is required when hemodynamic instability persists or heart failure progresses.
Surgery involves mitral valve repair when feasible, or valve replacement when repair is not possible.
Surgical risk is higher in emergency settings, and outcomes depend largely on the patient’s preoperative condition.
Chronic ischemic mitral regurgitation (papillary muscle dysfunction)
Chronic ischemic mitral regurgitation occurs when myocardial infarction impairs papillary muscle function.
This may involve papillary muscle displacement due to left ventricular remodeling, as well as dilation of the mitral annulus.
In some patients, reduced left ventricular function may also be present.
Symptoms and diagnosis in chronic cases
Symptoms may include shortness of breath, reduced exercise tolerance, and, in some cases, chest discomfort.
Echocardiography allows assessment of regurgitation severity and left ventricular function.
Treatment strategy in chronic cases
Treatment follows the general principles of mitral regurgitation management while addressing underlying coronary artery disease.
When revascularization is indicated, coronary artery bypass surgery may be combined with mitral valve repair.
-
Mitral valve repair:
Preferred when feasible to preserve native valve function -
Mitral valve replacement:
Considered when regurgitation is severe or repair is not suitable -
Coronary revascularization:
Percutaneous or surgical approaches are selected based on coronary anatomy -
Observation:
Mild regurgitation may be managed with careful follow-up
Follow-up
Regular follow-up with echocardiography is important to monitor regurgitation severity and left ventricular function over time.
Appointment
Appointments are required in principle. A referral letter from another medical institution is recommended but not mandatory.
For appointment requests and language support, please see the
Cardiovascular Center page.