Mitral Regurgitation Medical Slides

Present primary MR as intrinsic valve pathology (degenerative, endocarditis, rheumatic) with normal LV geometry, versus secondary MR as functional regurgitation from LV dilation/dysfunction or atrial annular dilation with structurally normal leaflets. This distinction is critical because it determines whether the treatment target is the valve itself (surgery/repair) or the underlying LV disease (GDMT, CRT, transcatheter repair).

Present the key difference: COAPT enrolled patients with disproportionately severe MR relative to LV dilation (EROA ≥30 mm², LVEDV <96 mL/m²) on optimized GDMT, while MITRA-FR included proportionate MR with larger ventricles and less optimized medical therapy. The teaching concept of "proportionate vs disproportionate MR" helps learners understand why patient selection determines outcomes.

Present the 2020 ACC/AHA Class I indications: symptomatic severe MR, asymptomatic with LVEF 30-60% or LVESD ≥40 mm. Include Class IIa triggers: new atrial fibrillation, resting PASP >50 mmHg, and progressive LV dilation. Emphasize that repair is preferred over replacement when feasible (>95% success at experienced centers), with lower operative mortality and better long-term outcomes.