Page 111 - Clinical Pearls in Cardiology

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6 Valvular Heart Diseases

1. What are the common causes of mitral regurgitation?
Mitral regurgitation is the abnormal ejection of blood
from the left ventricle into the left atrium during
systole. It is the most common valve lesion in adults,
and it may occur in acute or chronic form with varying
hemodynamic sequelae. The important causes of
chronic mitral regurgitation are the following:
• Post-inflammatory—in rheumatic fever, SLE, etc.
• Degenerative—in MVP, Marfan’s syndrome, Ehler-
Danlos syndrome, etc.
• Infiltrative—in amyloidosis, Hurler’s disease, etc.
• Infective—in endocarditis.
• Congenital mitral regurgitation.
• Functional mitral regurgitation—due to dilatation of
the mitral valve annulus secondary to diseases of the
myocardium like myocardial ischemia or cardio-
myopathies. The valve leaflets are normal.
The important causes of acute mitral regurgitation are
the following:
1. Ischemic: In inferior or posterior myocardial
infarction, there is rupture of papillary muscle. This
usually occurs between the 2nd and 5th day after the
acute infarction. The posteromedial papillary muscle
is commonly involved.
2. Perforation of the leaflets: In endocarditis, trauma,
etc.