MITRAL
REGURGITATION
NAME : samyutha.d.c
CLASS : B.P.T. 3rd YEAR
SHREE VENKATESWARA COLLEGE
OF PHYSIOTHERAPY
MITRAL VALVE
ANATOMY:
The MITRAL valve connects the left atrium (LA)
and left ventricle (LV)
The mitral valve opens during diastole ,to allow the
blood from the LA to the LV.
during ventricular systole ,the mitral valve closes
and prevents backfl ow to the LA
MITRAL
REGISTRATION
• Mitral regurgitation (MR) is defi ned as an abnormal
reversal of blood,from the left ventricle (LV) to left
atrium (LA)
• It is caused by any disruption of mitral valve(MV)
apparatus.
ETIOLOG
Y
The most common etiology of mitral valve
regurgitatiomitral valve prolapse
Rehumatic heart disease
Infective endocarditis
Annular calcification.
Ischemic heart disease
cardiomyopathy.
LESS
FREQUENTLY ,
• Collagen vascular
disease
• Trauma
• previous chest radiation
• Carcinoid disease
• exposure to certain
drugs
• Hypereosinophilic
CLASSIFICATIO
N:
• Primary mitral regurgitation
(PMR)
• secondray mitral regurgitaton
(SMR)
PRIMARY MITRAL VALVE
REGURGITATION
• It is caused by an abnormality in mitral
valve .
• And mostly due to myxomatous
degeneration.
• causes stretching out of valve leaflets and
chordae tendinae
• It coapting when the valve is closed , causing
RHEUMATIC HEART
DISEASE:
Here the cordinae tendinae will be thickening
and shortened ,producing restricted valvular
movement
Posterior dilation of mitral annulas also usually
present.
ISCHEMIC HEART
DISEASE:
Ischemic mitral regurgitation (IMR) is a type of mitral regurgitation that results from
ischemic heart disease, where a heart attack or other coronary artery disease
affects the heart's ability to function properly, leading to blood leaking back through
the mitral valve. This leakage occurs due to changes in the heart's structure and
function, rather than a direct problem with the valve itself.
SECONDARY MITRAL
REGISTRATION
Dilation of left ventricle , causing stretching of mitral
valve
annulus and displacement of papillary muscles
this dilation of left ventricle is due to any cause of dilated
cardiomyopathy , including aortic insufficiency
it is also called functional mitral regurgitaton, because
here
the papillary muscles, chordae tendinae and valve are
works normal
FUNCTIONAL
CLASSIFICATION
CARPENTER'S
CLASSIFICATION:
Type I: Normal Leaflet Motion
cause :Annular dilation( widening of mitral valve ring) or leaflets perforation (
small holes in leaflet )
Mechanisms:The leaflet move normally,but the valve doesn't close properly
due to structural issues
Example:A patient with an dilated annulus, where the valve leaflets are
otherwise normal but cannot coapt due to widening
Type II: Excessive Leaflet Motion
Cause:
Papillary muscle rupture, chordal rupture (rupture of the thin, string-like tendons
that connect the valve leaflets to the heart muscle), or redundant chordae (extra or
abnormally long chordae).
Mechanism:
The leaflets move excessively, leading to prolapse or flail leaflets (one or both
leaflets flapping back into the left atrium).
Example:
A patient with a ruptured chordae in the mitral valve, causing one or both leaflets to
move abnormally and regurgitate blood back into the left atrium.
Type III: Restricted Leaflet Motion
Type IIIa: Restricted in both systole and diastole:
Cause: Rheumatic heart disease, leading to leaflet thickening, retraction, or fusion,
and/or chordal thickening, shortening, or fusion.
Mechanism: The leaflets are restricted from moving freely during both phases of the
cardiac cycle.
Example: A patient with rheumatic heart disease, where the mitral valve leaflets are
thickened and fused, restricting their ability to open and close properly.
Type IIIb: Restricted in systole only:
Cause: Papillary muscle dysfunction or left ventricular dilation, leading to tethering
of the leaflets.
Mechanism: The leaflets are restricted from moving freely only during the systolic
phase of the cardiac cycle (when the heart contracts).
Example: A patient with left ventricular enlargement, causing the papillary muscles
to be displaced and tether the leaflets, preventing them from fully closing during
systole.
PATHOPHYSIOLO
GY:
The pathophysiology of the mitral regurgitaton is
classifie
classified into three phases of disease process
• Acute phase
• Chronic composated
phase
• Chronic decomposated
phase
ACUTE MITRAL REGISTRATION
(clinical manifestations) :
Shortness of breath with exertion.
Shortness of breath when lying flat.
Tiredness (fatigue).
Reduced ability to exercise.
Unpleasant awareness of your heartbeat.
Palpitations.
Swelling in your legs, abdomen, and the veins in your neck.
Chest pain (less common)
CHRONIC MITRAL
REGURGITATON
(CLINICAL MANIFESTATIONS )
Arrhythmia, Shortness of breath, especially
when lying down,Feelings of a rapid, pounding
or fluttering heartbeat, called palpitations
INVESTIGATIO
N
Electrocardiogram (ECG):
May reveal signs of left atrial and left ventricular enlargement, as well as
ischemia.
Chest X-ray:
May show cardiomegaly, pulmonary congestion, and pulmonary edema.
Echocardiogram:
A transthoracic echocardiogram is the gold standard for evaluating mitral
regurgitation, allowing for detailed assessment of valve structures,
regurgitation severity, and hemodynamic consequences.
ECG OF MITRAL
REGURGITATON
CHEST X RAY OF MITRAL
REGURGITATON
ECHOCARDIOGRAM OF MITRAL
REGURGITATON
CARDIAC
MRI
Cardiac MRI. This test uses magnetic fields and
radio waves to create detailed pictures of the
heart. Cardiac MRI may help show the severity
of mitral valve regurgitation. The test also gives
details about the lower left heart chamber.
CARDIAC
STAGING
The stage of heart valve disease depends on many things, including symptoms,
disease severity, the structure of the valve or valves, and blood flow through the
heart and lungs.
Heart valve disease is staged into four basic groups:
Stage A: At risk. Risk factors for heart valve disease are present.
Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve
symptoms.
Stage C: Asymptomatic severe. There are no heart valve symptoms, but the valve
disease is severe.
Stage D: Symptomatic severe. Heart valve disease is severe and is causing
symptoms.
Treatment
The goals of mitral valve regurgitation
treatment are to:
Help the heart work better.
Reduce symptoms.
Prevent complications.
Diuretics : for left ventricle disfunction
beta blockers : for primary treatment of left
ventricle disfunction of mitral regurgitaton
presence of atrial fibrillation calcium channel
blockers
SURGICAL
MANAGEMENT
• Mitral valve
replacement
• repair of leaflet
perforation
• annuloplasty
THANK
YOU...!
