Primary Mitral Regurgitation

Question 1

Moderate MR Hemodynamics

Answer 1

*Central jet MR 20%–40% LA or late systolic eccentric jet MR
* Vena contracta <0.7 cm
* Regurgitant volume <60 mL
* Regurgitant fraction <50%
* ERO <0.40 cm2
* Angiographic grade 1+ to 2+

Question 2

Severe MR Hemodynamics

Answer 2

• Central jet MR >40% LA or holosystolic eccentric jet MR
• Vena contracta ≥0.7 cm
• Regurgitant volume ≥60 mL
• Regurgitant fraction ≥50%
• ERO ≥0.40 cm2
• Angiographic grade 3+ to 4+

Question 3

Recommendations for Intervention for Chronic Primary MR?

Answer 3

1. In symptomatic patients with severe primary MR (Stage D).

* In asymptomatic patients with severe primary MR &:
1. LV systolic dysfunction (LVEF ≤60%,LVESD ≥40 mm) (Stage C2)
2. normal LV systolic function(LVEF ≥60% and LVESD ≤40 mm) (Stage C1), mitral valve repair is reasonable when the likelihood of a successful and durable repair without residual MR is >95% with an expected mortality rate of <1%, when it can be performed at a Primary or Comprehensive Valve Center.
3. normal LV systolic function (LVEF>60% and LVESD <40 mm) (Stage C1) but with a progressive increase in LV size or decrease in EF on ≥3 serial imaging studies.