Treatment of Mitral Valve Prolapse with Acute Severe Mitral Regurgitation and Hemodynamic Decompensation
Clinical Scenario
This protocol addresses mitral valve prolapse presenting with acute severe primary mitral regurgitation accompanied by acute hemodynamic decompensation — a high-acuity situation that requires prompt intervention. Severe acute MR, which may occur from chordal rupture, typically produces rapid haemodynamic deterioration.
Specific Situation
The patient has acute mitral regurgitation with acute hemodynamic compromise. Prompt surgical management — preferably mitral valve repair where feasible — is a critical part of the care pathway for symptomatic patients in this setting. Bridging stabilisation before the definitive procedure is a key component of the approach.
Treatment Approach (Partial)
Mechanical circulatory support targeting afterload reduction plays a central role in stabilising the patient with acute hemodynamic compromise ahead of the definitive procedure. The full protocol specifies the recommended device strategies, sequencing, and additional interventions.
Complete regimen, sequencing, and decision algorithm available via the link below.
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.
Intra-aortic balloon counterpulsation can be helpful to treat acute severe MR.
By lowering systolic aortic pressure, intra-aortic balloon counterpulsation decreases LV afterload, increasing forward output while decreasing regurgitant volume.
The use of a percutaneous circulatory assist device may stabilize a patient with acute hemodynamic compromise before the procedure.
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