mitralisklaffregurgitation

Mitralisklaffregurgitation, also known as mitral valve regurgitation (MR) or mitral insufficiency, is a heart valve disorder in which blood leaks backward from the left ventricle into the left atrium during systole because of a dysfunctional mitral valve apparatus.

Causes are classified as primary (degenerative or organic) and secondary (functional). Primary MR results from intrinsic abnormalities of the mitral valve leaflets, chordae tendineae, or the annulus, as seen in myxomatous degeneration, leaflet prolapse, chordae rupture, rheumatic disease, or infective endocarditis. Secondary MR occurs when the left ventricle or papillary muscles are dilated or dysfunctional (for example after ischemic heart disease or dilated cardiomyopathy), causing the leaflets to fail to coapt properly despite structurally normal valve tissue.

Pathophysiology involves a volume overload of the left atrium and left ventricle, leading to compensatory eccentric hypertrophy and progressive chamber dilation. Chronic MR can cause left-sided congestive symptoms and, over time, reduced LV function and pulmonary hypertension.

Clinical presentation ranges from asymptomatic to symptoms of heart failure. A hallmark is a holosystolic murmur best heard at the apex with radiation to the axilla. Exam may reveal an S3 and signs of volume overload. Many patients with mild MR remain stable for years; symptoms, LV dysfunction, or pulmonary congestion prompt intervention.

Diagnosis relies on echocardiography to quantify regurgitant severity, evaluate valve anatomy, and assess LV size and function. Additional imaging or ECG may be helpful. Management hinges on severity and symptoms: observation for mild cases; medical therapy for symptoms and comorbidity management; mitral valve repair (preferred when feasible) or replacement; transcatheter approaches (such as edge-to-edge repair) for high-risk surgical patients.

Prognosis depends on MR severity, LV function, and timely treatment; untreated severe MR carries risk of heart failure and arrhythmias.