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Abstract
Mitral regurgitation affects more than 2 million people in the USA. The main causes
are classified as degenerative (with valve prolapse) and ischaemic (ie, due to consequences
of coronary disease) in developed countries, or rheumatic (in developing countries).
This disorder generally progresses insidiously, because the heart compensates for
increasing regurgitant volume by left-atrial enlargement, causes left-ventricular
overload and dysfunction, and yields poor outcome when it becomes severe. Doppler-echocardiographic
methods can be used to quantify the severity of mitral regurgitation. Yearly mortality
rates with medical treatment in patients aged 50 years or older are about 3% for moderate
organic regurgitation and about 6% for severe organic regurgitation. Surgery is the
only treatment proven to improve symptoms and prevent heart failure. Valve repair
improves outcome compared with valve replacement and reduces mortality of patient
with severe organic mitral regurgitation by about 70%. The best short-term and long-term
results are obtained in asymptomatic patients operated on in advanced repair centres
with low operative mortality (<1%) and high repair rates (>/=80-90%). These results
emphasise the importance of early detection and assessment of mitral regurgitation.