With Mitral Regurgitation, Diagnosis Can Confuse Patients

(SANEPR.com) June 3, 2009 -- Although mitral regurgitation impacts two percent (2%) of the United States population, many patients do not understand the different, diagnostic categories that describe the severity of this valvular disease.

The mitral valve, which lies between the left atrium and the left ventricle of the heart, is a two-leaflet valve that ensures blood flow through the heart in one direction. When the mitral valve fails to close properly, often due to mitral valve prolapse, blood can leak back (regurgitation) into the heart forcing it to pump harder. Overtime, mitral valve regurgitation can lead to an enlarged heart or even congestive heart failure.

While most patients with mitral regurgitation proceed through life with only a slightly audible, heart murmur, other patients require surgical treatment – mitral valve repair or mitral valve replacement - to prevent heart damage.

To monitor patients with mitral valve regurgitation, three diagnostic categories have been established. According to the Mitral Valve Repair Center, an organization managed by Dr. David Adams, a heart surgeon with Mount Sinai Hospital in New York, the main determinants in quantifying mitral regurgitation are regurgitation volume and effective regurgitant orifice levels.

Regurgitation volume (measured in ml) is the difference between the mitral and aortic stroke volumes. Effective regurgitant (measured in mm2)is the ratio of regurgitant volume to the regurgitant time velocity integral.

Echocardiography is used to detect these measurements and monitor mitral regurgitation using the following guidelines:

• Mild mitral regurgitation has regurgitant volume less than 30 and an effective regurgitant level less than 20.
• Moderate mitral valve regurgitation has regurgitant volume between 30 and 59 and an effective regurgitant level between 20 and 39.
• Severe mitral valve regurgitation has regurgitant volume greater than 60 and an effective regurgitant level greater than 40.

While traditional, two dimensional echocardiography with doppler is essential to determine the severity of mitral regurgitation, a cardiologist may elect to use transesophageal echocardiography (TEE) to confirm the diagnosis.

“I receive many, many, many emails from patients about the severity of their mitral regurgitation diagnosis,” notes Adam Pick, founder of www.Heart-Valve-Surgery.com and author of The Patient’s Guide To Heart Valve Surgery. “I think we really need to educate and prepare the patient community about what might happen if their mitral regurgitation proceeds from mild to moderate to severe levels,” Pick concluded.