Treatment of Acute Mitral Regurgitation in Severe Primary Mitral Regurgitation

Clinical scenario

This protocol addresses acute mitral regurgitation arising in the setting of severe primary mitral regurgitation (PMR) — a structurally driven valvular disease requiring careful patient selection to determine the appropriate intervention.

Specific population

The key clinical distinction is the severity and primary (degenerative or structural) origin of the mitral regurgitation. Management decisions hinge on symptom status, anatomical suitability, and the estimated surgical risk — factors that together guide the choice of intervention.

Treatment approach — partial overview

In symptomatic patients with severe primary mitral regurgitation who are anatomically suitable and carry a high surgical risk, a catheter-based transcatheter approach to valve repair is among the interventions considered by the multidisciplinary Heart Team.

Full algorithm, patient-selection criteria, and sequencing available in the complete protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehaf194

Surgical MV repair is recommended in low-risk asymptomatic patients with severe PMR without LV dysfunction (LVESD <40 mm, LVESDi <20 mm/m², and LVEF >60%) when a durable result is likely, if at least three of the following criteria are fulfilled.

TEER should be considered in symptomatic patients with severe PMR who are anatomically suitable and at high surgical risk according to the Heart Team.

View source ↗