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Medical Management

Medications to Treat Mitral Valve Regurgitation

You and your medical team may decide medical management is most appropriate for you.  Such patients might have a less than severe mitral regurgitation or stenosis (or none at all, just prolapse), be deemed too high risk for surgery relative to the benefits, or have a valve that is not likely repairable in the setting of no symptoms and a normal heart.  

Medical management of both mitral stenosis or regurgitation generally includes diuretics ("water pills") to reduce the amount of fluid buildup in the body and control of high blood pressure.  Once mitral disease becomes severe, medicine is generally not as effective as surgery provided the patient is a candidate for surgery.  A recent paper concluded that early surgical repair of mitral valve regurgitation was associated with greater long-term survival and freedom from heart failure than medical management.

Asymptomatic Patients with Mitral Regurgitation Fare Better With Surgery
Asymptomatic patients with mitral regurgitation had higher survival with surgery versus medical management.  JAMA. 2013. Aug 14. 310(6): 609-16.

 

Medications that reduce blood pressure ("afterload-reducing" agents) such as nitrates and blood pressure medications can help along with the diuretics or "water pills".  These help to keep blood moving forward rather than backwards.  Some patients with mitral regurgitation may benefit from a biventricular pacer because the regurgitation can be caused by electrical "dysynchrony" of the electrical conducting system of the heart.

If atrial fibrillation is also present, it can worsen symptoms of mitral regurgitation.  Atrial fibrillation can be caused by mitral regurgitation.  Proper treatment of the atrial fibrillation with beta blockers, calcium channel blockers, anti-arrhythmic drugs, or even electrical cardioversion can help with symptoms.  Anticoagulation with blood thinners may be required.

Although guidelines are evolving, in general antibiotics are recommended in patients with significant mitral valve disease or previous mitral valve surgery prior to any procedure that involves manipulation of gingival tissue, the periapical region of a tooth, or oral mucosa perforation.

A recent study using data from the Mitral Regurgitation International Database (MIDA) found that patients with severe MR without symptoms, an enlarged or dysfunctional heart, atrial fibrillation or pulmonary hypertension had a significantly higher survival over years when they were treated with surgery rather than medical therapy alone. (Suri RM, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA. 2013 Aug 14. 310(6):609-16.)