Treatment of Acute Severe Primary Mitral Regurgitation

Acute severe primary mitral regurgitation (PMR) is a haemodynamically critical presentation that is poorly tolerated and typically requires urgent evaluation and intervention.

Clinical Scenario

This protocol addresses patients with acute severe primary mitral regurgitation. Because acute severe PMR is poorly haemodynamically tolerated, urgent surgical or transcatheter treatment is indicated.

Management Approach

Bridging stabilisation centres on afterload reduction as a key strategy in appropriate patients, alongside measures targeting filling pressures and pulmonary congestion — with further mechanical options reserved for select situations.

Full regimen details, sequencing, and selection criteria are in the structured protocol below.

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References

DOI: 10.1093/eurheartj/ehaf194

Urgent surgery or transcatheter treatment is indicated in patients with acute severe PMR because it is poorly haemodynamically tolerated.
Afterload reduction with sodium nitroprusside has been used as a bridge to an intervention in patients with acute severe PMR without signs of hypotension.
Inotropic agents and diuretics are usually indicated to reduce filling pressures and control pulmonary congestion, while the implantation of an intra-aortic balloon pump helps to further reduce afterload in exceptional cases of acute PMR.

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