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Nowadays, mitral regurgitation (MR) already represents a major health problem, and has been recognised as the most frequent valvular disease in the USA and the second most common form of valve disease requiring surgery in Europe.1 2 In the future, due to the ageing and growth of the general population, the negative impact of MR on patients' health is expected to increase further.3 As healthcare providers, we will thus be more and more frequently called upon to challenge this disease, which is indeed extremely heterogeneous in terms of prognosis and treatment options.3
This article aims to provide a practical, step-by-step approach to the daily management of asymptomatic MR in the light of the most recent diagnostic and therapeutic advances.
Essential knowledge required to approach any patient presenting with any amount of MR
A diagnosis of MR should be made in the presence of a pathological amount of blood regurgitating from the left ventricle (LV) into the left atrium (LA) because of an incompetent mitral valve (MV). The mere detection of MR is not sufficient for diagnosis, and for correct decision making we also need to assess: (1) the aetiology; (2) the mechanism (ie, how the disease prevents the MV from being competent); and (3) the severity of the regurgitation. An appropriate and comprehensive diagnosis not only enhances communication, but more importantly leads to a different prognostic assessment and therapeutic management.
The numerous aetiologies of MR can be roughly grouped into either ischaemic (ie, due to coronary artery disease) or non-ischaemic (all other causes), and the mechanisms into organic or functional.
Mechanisms of mitral regurgitation
Organic MR is due to one or more anatomic abnormalities intrinsically affecting the mitral valve itself or the sub-valvular apparatus (mainly degenerative processes, ageing, rheumatic heart disease, or endocarditis) (figure 1). Papillary muscle rupture represents the only organic MR with an ischaemic aetiology.
Functional MR occurs in the presence of …