Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension [1]. When atrial fibrillation due to left atrium dilatation occurs, most patients experience palpitations. In children, failure to thrive is an important hallmark of almost all serious heart conditions.

When mitral regurgitation happens abruptly, being caused by an acute accident like chordal or papillary muscle rupture due to myocardial infarction, compensatory mechanisms do not have time to install and symptoms are dramatic, as patients present with pulmonary edema or cardiogenic shock. In chronic severe mitral regurgitation, patients slowly progress to congestive heart failure and pulmonary edema [2].

A clinical examination reveals a left atrial lift caused by the left atrium filling with blood during systole. The first heart sound is normal or diminished, while the second heart sound is split into early stages of the disease because the aortic valve closes early. The splitting interval diminishes as pulmonary hypertension starts [1]. A third sound caused by increased ventricular filling may also appear, while the pulmonary component of the second heart sound is accentuated if pulmonary hypertension has begun. Mitral valve prolapse is accompanied by an ejection systolic click.

The murmur caused by mitral regurgitation is best heard at the apex and radiates towards the axilla and subscapular area. It is usually pansystolic, but may also be presystolic in acute settings or telesystolic in mitral valve prolapse or papillary muscle dysfunction. The intensity decreases as the left ventricle dysfunction advances [2].

Peripheral pulse is sharp but has a small volume; atrial fibrillation presents late in the course of the disease and the characteristic pulse abnormality is noted. The dilated left atrium may compress the left main bronchus, leading to wheezing and, rarely, lung atelectasis and hyperinflation.

The postero-anterior radiography may show a normal aspect of the heart or enlarged left atrium and left atrial appendage; if mitral regurgitation begins abruptly, the X-ray shows signs of pulmonary edema with normal sized left atrium. The pulmonary edema might be more prominent in the right upper lobe [3]. Cardiomegaly is present in chronic regurgitations.

Echocardiography is the most valuable tool in assessing mitral regurgitation. Two-dimensional (2D) echocardiography is useful in measuring heart dimensions and characterizing the mitral apparatus while trying to identify the cause of the disease and associated abnormalities. Color flow echocardiography describes the direction of the flow [4]. Quantitative and semi-quantitative measurement methods should be used in evaluating disease severity [5].

Spectral Doppler (pulse and continuous) is useful in calculating the severity of the regurgitation (by measuring parameters such as vena contracta, proximal isovelocity surface area, and regurgitant fraction) and evaluating a possible concomitant mitral stenosis [5]. If doubt about severity persists, stress echocardiography and exercise testing should be performed [2].

Transesophageal echocardiography and heart catheterization are indicated in cases where heart anatomy is uncertain [6], whereas cardiac magnetic resonance imaging (MRI) is more accurate in determining ventricular function and size. Catheterization is also useful in grading the regurgitation [7].

Electrocardiography shows rhythm and conduction abnormalities, left atrial enlargement and right ventricular hypertrophy if pulmonary hypertension is present.

Brain natriuretic peptide has prognostic value in severe mitral regurgitation and can be used in risk stratification [8].

Treatment for Mitral Valve Insufficiency depends on the severity of the condition and the presence of symptoms. In mild cases, regular monitoring and lifestyle changes may be sufficient. For more severe cases, medications such as diuretics, beta-blockers, or ACE inhibitors may be prescribed to manage symptoms. In some instances, surgical intervention may be necessary to repair or replace the mitral valve. The choice of treatment is tailored to each patient's specific needs and overall health.

The prognosis for individuals with Mitral Valve Insufficiency varies based on the severity of the condition and the effectiveness of treatment. With appropriate management, many patients can lead normal, active lives. However, if left untreated, severe mitral regurgitation can lead to complications such as heart failure or atrial fibrillation, which can significantly impact quality of life and life expectancy.

Mitral Valve Insufficiency can result from various causes. It may be due to degenerative changes in the valve, such as mitral valve prolapse, where the valve flaps become floppy. Other causes include rheumatic heart disease, endocarditis (infection of the heart valves), or damage from a heart attack. In some cases, it may be congenital, meaning present at birth.

Mitral Valve Insufficiency is a common heart valve disorder, affecting millions of people worldwide. It is more prevalent in older adults, as the risk increases with age. The condition is slightly more common in men than in women. The prevalence of mitral regurgitation is also higher in individuals with a history of heart disease or those with certain genetic predispositions.

In Mitral Valve Insufficiency, the mitral valve fails to close completely during the heart's contraction phase, known as systole. This incomplete closure allows blood to leak backward from the left ventricle into the left atrium. Over time, this can lead to increased pressure in the left atrium and pulmonary circulation, causing symptoms such as shortness of breath and fatigue. The heart may also enlarge as it works harder to maintain adequate blood flow.

While not all cases of Mitral Valve Insufficiency can be prevented, certain measures can reduce the risk. Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, can support heart health. Managing underlying conditions such as high blood pressure, diabetes, and high cholesterol is also important. Regular medical check-ups can help detect early signs of valve problems, allowing for timely intervention.

Mitral Valve Insufficiency is a condition where the heart's mitral valve does not close properly, leading to backward blood flow. It can cause symptoms like shortness of breath and fatigue, and if left untreated, may result in serious complications. Diagnosis involves physical examination and imaging tests, while treatment ranges from lifestyle changes to medication and surgery. With appropriate management, many patients can maintain a good quality of life.

If you have been diagnosed with Mitral Valve Insufficiency, it's important to follow your doctor's recommendations and attend regular follow-up appointments. Understanding your condition and treatment options can empower you to make informed decisions about your health. Adopting a heart-healthy lifestyle and managing any other medical conditions can help you live well with this condition.

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2. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012;33(19):2451-2496.
3. Schnyder PA, Sarraj AM, Duvoisin BE, et al. Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe. AJR Am J Roentgenol. 1993;161(1): 33-36.
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5. Zoghbi WA, Enriquez-Sarano M, Foster E et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16(7):777-802.
6. Calafiore AM, Gallina S, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated? a propensity score analysis. Ann Thorac Surg. 2009;87(3):698-703.
7. Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):e84-231.
8. Pizarro R, Bazzino OO, Oberti PF, et al. Prospective validation of the prognostic usefulness of brain natriuretic peptide in asymptomatic patients with chronic severe mitral regurgitation. J Am Coll Cardiol. 2009;54(12):1099-1106.