Mitral Incompetence / Mitral regurgitation

Mitral Incompetence/Mitral regurgitation (MR) or mitral insufficiency  is a disorder of the heart in which the mitral valve does not close properly when the heart pumps out blood. It is the abnormal leaking of blood from the left ventricle, through the mitral valve, and into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium. MR is the most common form of valvular heart disease.

Aetiology of Mitral Incompetence

(1) Rheumatic

(2) Dilated cardiomyopathy (DCMP)

(3) Mitral annulus calcification

(4) Palpillary muscle dysfunction

(5) Connective tissue disorders

(6) Marfan syndrome

(7) AV cushion defect

(8) Bacterial endocarditis

(9) Annomalous left attachment

(10) Absent papillary muscle

(11) Mitral arcade

(12) Ventricular aneurysm

(13) Chest trauma

(14) Mitral Valve Prolapse (MVP).

Physical Examination of Mitral Incompetence

Normal arterial pulse and Jugular Venous Pulse.

Apical impulse hyperdynamic, displaced down and out.

Soft S1.

Wide split S2 due to earlier A2.

Pansystolic soft high pitched blowing murmur on apex radiating to axilla, often accompanied by a systolic thrill.

Measures that reduce after load decrease the murmur and that increase the after load increase the murmur.

ECG

Enlarged LA, often atrial fibrillation.

Left ventricular hypertrophy in half patients and biventricular hypertrophy in quarter patients.

Doppler

Assess degree of regurgitation and atrial / ventricular dilatation.

L.V. performance (Ejection fraction).

Treatment for Mitral Incompetence

For mild cases, treatment may not be necessary.

Treatment of Congestive Heart Failure (CHF) with digoxin, diuretic and vasodilators

Rheumatic fever prophylaxis

Prophylaxis for infective endocarditis

 Surgical

Annulopasty / valve replacement if LV. function compromised.

Operation is usually necessary when patient has symptoms or in an asymptomatic patient with EF < 50% or LV enddiastolic dimension > 5 cm. in Echo.

Prognosis of Mitral Incompetence

The outcome varies. Usually the condition is mild, so no therapy or restriction is needed. Symptoms can usually be controlled with medication.

Left untreated, severe mitral valve regurgitation can cause heart failure or serious heart rhythm problems (arrhythmias).