This protocol addresses mitral valve prolapse presenting as acute severe primary mitral regurgitation complicated by acute hemodynamic decompensation — a critical, time-sensitive clinical emergency.

Clinical Situation

Acute severe primary mitral regurgitation — such as that arising from chordal rupture — typically causes sudden, severe hemodynamic decompensation. Prompt surgical evaluation, preferably for mitral valve repair when feasible, is lifesaving in the symptomatic patient.

Initial Treatment Approach

Bridging haemodynamic stabilisation centres on intravenous vasodilator therapy to reduce impedance of aortic flow and improve cardiac compensation. The specific agent, titration strategy, and full management algorithm are detailed in the complete protocol.

References

DOI: 10.1161/CIR.0000000000000923

The patient with severe acute MR, which might occur from chordal rupture, usually experiences acute hemodynamic decompensation.

Prompt mitral valve surgery, preferably mitral repair if possible, is lifesaving in the symptomatic patient with acute severe primary MR.

Vasodilator therapy improves hemodynamic compensation in acute MR.

This is usually accomplished by infusion of an easily titratable agent, such as sodium nitroprusside or nicardipine.

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Treatment of Mitral Valve Prolapse with Acute Severe Mitral Regurgitation and Hemodynamic Decompensation

References