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Mitral regurgitation aff ects more than 2 million people in the USA. The main causes are classifi ed as degenerative (with valve prolapse) and ischaemic (ie, due to consequences of coronary disease) in developed countries, or rheumatic (in developing countries).
Review Mitral regurgitation Maurice Enriquez-Sarano, Cary W Akins, Alec Vahanian Lancet 2009; 373: 1382–94 Published Online April 7, 2009 DOI:10.1016/S01406736(09)60692-9 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA (Prof M Enriquez-Sarano FACC); Division of Cardiac Surgery, Harvard Medical School, Boston, MA, USA (Prof C W Akins MD); and Cardiology Department, Hopital Bichat, University of Paris, Paris, France (Prof A Vahanian FESC) Correspondence to: Prof Maurice Enriquez-Sarano, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Sarano.maurice@mayo.edu Mitral regurgitation affects more than million people in the USA The main causes are classified as degenerative (with valve prolapse) and ischaemic (ie, due to consequences of coronary disease) in developed countries, or rheumatic (in developing countries) This disorder generally progresses insidiously, because the heart compensates for increasing regurgitant volume by left-atrial enlargement, causes left-ventricular overload and dysfunction, and yields poor outcome when it becomes severe Doppler-echocardiographic methods can be used to quantify the severity of mitral regurgitation Yearly mortality rates with medical treatment in patients aged 50 years or older are about 3% for moderate organic regurgitation and about 6% for severe organic regurgitation Surgery is the only treatment proven to improve symptoms and prevent heart failure Valve repair improves outcome compared with valve replacement and reduces mortality of patient with severe organic mitral regurgitation by about 70% The best short-term and long-term results are obtained in asymptomatic patients operated on in advanced repair centres with low operative mortality (