Mitralisinsufficiens

Mitral insufficiency, also known as mitral regurgitation (MR), is a disorder of the mitral valve in which blood leaks backward from the left ventricle into the left atrium during systole due to incomplete valve closure. The condition can be primary (organic) when the valve itself is diseased, or secondary (functional) when the valve structure is normal but left ventricular dilatation or remodeling prevents proper leaflet coaptation.

Common causes of primary MR include mitral valve prolapse, rheumatic disease, degenerative degeneracy of the leaflets, and infective endocarditis. Secondary MR often arises from myocardial diseases such as ischemic heart disease or dilated cardiomyopathy, where LV dilation displaces the papillary muscles and tethering of the leaflets reduces closure. The result is a volume overload of the left atrium and, over time, the left ventricle to maintain forward flow.

Patients may be asymptomatic for years or present with exertional dyspnea, fatigue, orthopnea, or palpitations. On examination a holosystolic murmur is typically heard at the apex, often radiating to the axilla; signs of heart failure can accompany advanced disease. Diagnosis relies on echocardiography with Doppler to quantify regurgitant volume, the effective regurgitant orifice area, and assess LV function. Chest imaging and electrocardiography assist in evaluation and management.

Management depends on severity, symptoms, and LV function. Mild MR is usually monitored. Medical therapy focuses on symptom relief and congestion control with diuretics; afterload-reducing medications may help functional MR. Definitive treatment for severe MR, especially with symptoms or LV dysfunction, is mitral valve repair or replacement, with repair preferred when feasible. Transcatheter approaches (eg, edge-to-edge repair) offer options for high-risk patients. Prognosis improves with timely intervention.