Treatment: Mitral Regurgitation

For severe/decompensated MR, treat as for heart failure (Chap. 124. Heart Failure and Cor Pulmonale). IV vasodilators (e.g., nitroprusside) are beneficial for acute, severe MR (See fig. 114-2). Anticoagulation is indicated in the presence of atrial fibrillation. For chronic primary MR, surgical treatment, either valve repair or replacement, is appropriate if pt has symptoms or evidence of progressive LV dysfunction (e.g., LV ejection fraction [LVEF] ≤60% or end-systolic LV diameter by echo ≥40 mm). Operation should be carried out before development of chronic heart failure symptoms. Pts with functional ischemic MR may require coronary artery revascularization along with valve repair. Functional nonischemic MR due to LV enlargement with impaired contractile function should be treated with aggressive heart failure therapies and consideration of cardiac resynchronization therapy (Chap. 124. Heart Failure and Cor Pulmonale).