Treatment
The treatment of mitral regurgitation depends on the acuteness of the disease and whether there are associated signs of hemodynamic compromise.
In acute mitral regurgitation secondary to a mechanical defect in the heart (i.e. rupture of a papillary muscle or chordae tendineae), the treatment of choice is urgent mitral valve replacement. If the patient is hypotensive prior to the surgical procedure, an intra-aortic balloon pump may be placed in order to improve perfusion of the organs and to decrease the degree of mitral regurgitation.
If the individual with acute mitral regurgitation is normotensive, vasodilators may be of use to decrease the afterload seen by the left ventricle and thereby decrease the regurgitant fraction. The vasodilator most commonly used is nitroprusside.
Individuals with chronic mitral regurgitation can be treated with vasodilators as well to decrease afterload. In the chronic state, the most commonly used agents are ACE inhibitors and hydralazine. Studies have shown that the use of ACE inhibitors and hydralazine can delay surgical treatment of mitral regurgitation. The current guidelines for treatment of mitral regurgitation limit the use of vasodilators to individuals with hypertension, however. Any hypertension is treated aggressively, e.g. by diuretics and a low sodium diet. In both hypertensive and normotensive cases, digoxin and antiarrhythmics are also indicated. Also, chronic anticoagulation is given where there is concomitant mitral valve prolapse or atrial fibrillation.
There are two surgical options for the treatment of mitral regurgitation: mitral valve replacement and mitral valve repair. In the double orifice technique for mitral valve repair, the opening of the mitral valve is sewn closed in the middle, leaving the two ends still able to open. This ensures that the mitral valve closes when the left ventricle pumps blood, yet allows the mitral valve to open at the two ends to fill the left ventricle with blood before it pumps. The same idea can be used with a minimally-invasive catheter technique which installs a clip to hold the middle of the mitral valve closed.
There is also a non-surgical option for the treatment of mitral regurgitation. Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaeneous implantation of a clip that grips and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. Though it is less effective at reducing mitral regurgitation than conventional surgery, the procedure is marked by superior safety and similar improvements.
Read more about this topic: Mitral Regurgitation
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