Description:

The trusted landmark cardiology resource-thoroughly updated to reflect the latest clinical perspectives. Through thirteen editions, Hurst's the Heart has always represented the cornerstone of current scholarship in the discipline. Cardiologists, cardiology fellows, and internists from across the globe have relied on its unmatched authority, breadth of coverage, and clinical relevance to help optimize patient outcomes. The section on valvular heart disease has four of the six chapter completely rewritten by authors who are authorities in the field.

Chapter 77: Mitral Valve Regurgitation

David H. Adams, Blase A. Carabello, and Javier Castillo
Pages 1721-1737

Excerpt:
“The normal mitral valve permits one-way blood flow from the left atrium to the left ventricle (LV) in an efficient, nearly frictionless fashion. Although even a normal competent valve may allow a trivial amount of reversed flow, more than a trace of mitral regurgitation is considered pathologic. Mild to moderate mitral regurgitation is tolerated indefinitely as long as it does not worsen. However, severe mitral regurgitation causes LV remodeling, reduced forward cardiac output, neurohumoral activation, LV damage, heart failure, and ultimately death. The natural history of mitral regurgitation depends intimately on its etiology, the severity of LV volume overload and its contractile performance, and the appearance of overlapping clinical conditions secondary to reversal of flow such as atrial fibrillation and pulmonary hypertension. In this setting, myxomatous degeneration of the mitral valve, a common pathologic substrate of mitral valve billowing (normal valve coaptation) and prolapse (deficient valve coaptation), is the most prevalent cause of isolated severe mitral regurgitation requiring surgical intervention in the United States. The following is a review of the normal mitral valve anatomy, as well as a summary of causes, consequences, and treatment of degenerative mitral vale regurgitation.”