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THE MITRAL INSUFFICIENCY

- Definition
- A few explanations
- The Symptoms
- How to make the diagnosis?
- The severity of the mitral insufficiency
- The Causes
- Evolution
- The preoperative check-up
- Treatment
- Conclusion

TREATMENT

1 - Goal

The treatment consists in establishing an adapted surveillance in case of a mitral insufficiency without symptoms.

Physicians must debate a mitral valvular replacement surgery in case of a mitral insufficiency associated to symptoms.

2 - Means

The treatment especially consists in fighting against the complications of the mitral insufficiency:

- It is imperative to avoid the occurrence of an infective endocarditis;

- The treatment of the atrial fibrillation will be based on an anticoagulant treatment;

- The treatment of the left cardiac insufficiency will if necessary be achieved;

- Finally, if necessary, the surgeon will implant a mitral valvular prosthesis.

3 - Indications

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3 scenarii exist according to the importance of the chronic mitral regurgitation:

The moderate mitral insufficiency, which is not accompanied by symptoms, only justifies a surveillance every year or every 2-year, a prevention of the infective endocarditis notably in dental care. The physician, with the help of an electrocardiogram, must detect the atrial fibrillation.

The prognosis is generally good. A brutal aggravation may occur during a spontaneous cord rupture or during an infective endocarditis.

In some little or not symptomatic patients, an intervention can be justified by a change in the left cardiac function before symptoms occur.

In patients with symptoms, whether the regurgitation is acute or chronic, the surgical indication cannot be debated apart from a contraindication bound to the context (too old age, other associated illnesses, in particular respiratory illnesses, lesions at the level of the heart arteries). The operative prognosis is especially better since the cardiac function is preserved.

When the anatomical lesions permit it, a reconstruction of the mitral valve with the help of artificial devices (reconstitutive annulo-valvuloplasty) is preferable to a valvular replacement. It is possible in one third of the cases.

The mitral valvular replacement calls on mechanical prostheses... or on biologic prostheses (or bioprostheses).

Mechanical prostheses require the prescription of an associated anticoagulant treatment, which is not the case of biologic prostheses (or bioprostheses).

In the acute mitral insufficiency, a treatment in cardiology intensive care unit is necessary to fight against the acute pulmonary edema and to balancethese patients’ cardiac function before a semi-emergency surgery.

4 - Results

The operative risk is generally lower than 5%. It depends extensively on the cardiac function before surgery.

Long-term results are excellent whatever the type of intervention since, 10 years afterwards, 80% of the patients do not present symptoms and 1/3 could resume a professional activity.

5 - Surveillance

It is justified by the different complications according to the type of surgery. The replacement of a bioprosthesis occurs on average 10 years after. A conservative gesture does not shelter from a recidivation.

Consequently, the regular surveillance as well as the prevention from the infective endocarditis and the surveillance of a possible anticoagulant treatment is necessary.

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File last reviewed on dec 18, 2011