Management of Mitral Regurgitation

Management of Mitral Regurgitation - Flowchart

«Flowchart»

Mitral Regurgitation

Primary MR

Primary MR Primary MR

Secondary MR

Secondary MR Secondary MR

Persistent NYHA class III-IV symptoms

Periodic monitoring

MV surgery^* (IIb)

MV surgery^* (IIb) ^*

End

CAD Rx
HF Rx
consider CRT

Symptomatic severe MR (stage D)

Symptomatic severe MR

Asymptomatic severe MR (stage C)

Asymptomatic severe MR

Progressive MR (stage B)

Progressive MR

Periodic monitoring

Symptomatic (stage D)

Symptomatic

Asymptomatic (stage C)

Asymptomatic

MV surgery^* (I)

MV surgery^* (I) ^*

MV surgery^* (IIb)

MV surgery^* (IIb) ^*

LVEF >30%

Yes

MV repair (IIa)

Likehood of successful repair >95% and expected mortality <1%

Yes

Severe MR
Vena contracta 0.7 cm
RVol 60% cc
RF 50%
ERO 0.4 cm²
LV dilation

Severe MR

²
Severe MR

Progressive MR (stage B)
Vena contracta <0.7 cm
RVol <60% cc
RF <50% cc
ERO <0.4 cm²

Progressive MR

² Progressive MR

LVEF 30–59% or LVESD 40 mm (stage C2)

LVEF 30–59%

LVEF 60% and LVESD <40 mm (stage C1)

LVEF >=60%

New onset AF or PASP >50 mmHg (stage C1)

New onset AF