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Mitral regurgitation Treatment

1. Medical treatment:
Appropriate to avoid excessive manual labor and strenuous exercise, limiting sodium intake, the protection of cardiac function. Appropriate use of diuretics; vasodilator, through reducing left ventricular ejection resistance, can reduce the return flow, increased cardiac output, resulting in beneficial hemodynamic effects. Chronic patient can use angiotensin converting enzyme inhibitors. Patient with acute mitral regurgitation can use sodium nitroprusside or nitroglycerin, or intravenous phentolamine. Digitalis drugs should be used to occur in patients with heart failure, and atrial fibrillation were associated with more effective. Can be used in patients with advanced heart failure of anticoagulant drugs to prevent thromboembolism.

2. Surgery. After surgery, patients with mitral regurgitation improvement in cardiac function is superior to drug therapy; even with heart failure or atrial fibrillation in the patients, the efficacy of surgical treatment is better than drug treatment. Valve repair over prosthetic valve replacement surgery with low mortality rates, higher long-term survival, a smaller incidence of thrombo-embolism.

1) Preoperative preparation: before surgery, should be held in the left and right cardiac catheterization and left ventricular angiography. These checks on the diagnosis of mitral regurgitation, a clear primary myocardial disease, or functional mitral regurgitation have been very helpful; hemodynamics check valve involvement contribute to the valuation of the severity of disease; coronary angiography to determine whether there is a need at the same time in patients with coronary artery bypass grafting, because persons with coronary heart disease, high mortality rate of surgical complications and more.

2) Operative Indications:

  • Acute mitral regurgitation;
  • cardiac function 3 to 4, with positive medical treatment;
  • no significant clinical symptoms or cardiac function in two or two below, show that the examination heart to increased, decreased left ventricular ejection fraction.

    3. Surgery types:

  • valve repair: to maximize the preservation of the natural valve. For relaxation caused by mitral valve prolapse; tendons or fracture is too long; the limitations of rheumatic mitral valve disease, the former leaves a soft non-shrinkage and tendons although without fibrosis or calcification contracture; infection of the heart mitral valve endocarditis lesions confined to vegetation or perforation, the former leaves no or only minor damage.
  • artificial valve replacement: valve replacement with mechanical valves and biological valves. Mechanical valve, including ball valve, float valve and tilting disc valve disc, the advantages of high wear-resistant, but the incidence of thromboembolic high to be life-long anticoagulation therapy, after 10 years due to inadequate anticoagulation or anticoagulation-induced thrombo-embolism the occurrence of excessive bleeding due to illness and disability rates can be as high as 50%; Secondly, the mechanical valve of the eccentric flow, greater resistance to blood flow, higher PG. Biological valve, including porcine aortic valve, bovine pericardium dural flap valve and the same species, and its advantages for the low rate of occurrence of thromboembolic events, no life-long anticoagulation and with the center of the natural flow valve is similar, but not as strong mechanical valve. 3 to 5 years after the occurrence of degenerative changes in calcification damaged, 10 years approximately 50% required re-replacement.

    Young patients and high-risk atrial fibrillation or thromboembolism who required anticoagulant therapy should be selected mechanical valve; if the small ring, are advised to choose a better hemodynamic effect of the artificial valve; if there is bleeding tendency or anticoagulant taboos, as well as young women, after valve replacement fertility to pregnancy, to use the biological valve.

    • Submitted by Health Studies on Mon, 04/27/2009 - 22:25
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