Evaluation and Management of Chronic Mitral Regurgitation

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Abstract
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.A 56-year-old man with no history of cardiac disease and no cardiac symptoms has a holosystolic murmur at the apex that radiates to the axilla. Echocardiography shows moderate mitral regurgitation with mild left ventricular dilatation. How should this patient's care be managed?There are about 500,000 discharge diagnoses of mitral-valve disease annually in the United States.1 However, estimates of the prevalence of mitral regurgitation are confounded by the presence of benign flow murmurs in many adults and by the small amount of physiologic regurgitation detected on echocardiography in 80 percent of adults. Only about 18,000 patients undergo mitral-valve surgery . . .