Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

992 Mitral Insufficiency (MR)

management

■Medical

➣Antibiotic prophylaxis in all patients

➣Vasodilator therapy

➣Atrial fibrillation

Rate control with digoxin, beta-blockers or calcium blockers

Anticoagulation with warfarin

specific therapy

■Surgical repair or replacement of mitral valve

■Complications of mitral valve replacement

➣Acute

Complications of cardiopulmonary bypass

Increased acute mortality if LV systolic function depressed

➣Long-term

Thromboembolism

Valve failure

Bleeding from anticoagulation therap

Endocarditis

Mitral valve repair preferred over replacement

■Long-term complications significantly less with repair versus

replacement: anticoagulation may not be required with repair and

risk of valve failure not present (TEE helps predict repair vs. replace-

ment)

Indications for mitral valve surgery for patients with moderate/severe

MR:

■Moderate/severe symptoms due to MR

■Asymptomatic with LV dysfunction (LVEF < 60% or end-systolic

dimension > 45 mm)

■Asymptomatic with normal LV function

➣If TEE indicates repair possible – perform surgery

➣If TEE indicates replacement – delay surgery until symptoms or

LV dysfunction occur

follow-up

n/a

complications and prognosis

Prognosis

■Post mitral valve surgery

➣Survival very good if LVEF >60% and end-systolic dimension < 45

mm prior to surgery