THE CONTEXT
Mitral regurgitation has several structural and functional causes and may also follow mitral valvotomy or valvuloplasty. Selection for balloon valvuloplasty requires suitable mitral stenosis anatomy and absence of important regurgitation.
Causes of mitral regurgitation
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Rheumatic disease is the principal cause where rheumatic fever is common; other causes are more important elsewhere, including in the UK.
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Mitral valve prolapse can cause mitral regurgitation.
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Dilatation of the left ventricle and mitral valve ring produces functional mitral regurgitation in coronary artery disease or cardiomyopathy.
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Rheumatic heart disease and endocarditis can damage the valve cusps and chordae.
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Other listed causes include papillary muscle ischaemia or infarction and myocardial infarction.
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Mitral regurgitation may develop after mitral valvotomy or valvuloplasty.
Criteria for mitral valvuloplasty
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The patient should have significant symptoms and isolated mitral stenosis.
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Mitral regurgitation should be absent or trivial.
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Echocardiography should show a mobile, non-calcified valve and subvalve apparatus.
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The left atrium should be free of thrombus.
Balloon valvuloplasty procedure
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A guidewire is introduced from the femoral vein through the inferior vena cava into the right atrium.
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Puncturing the interatrial septum provides access to the left atrium and mitral valve.
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A balloon catheter is advanced over the guidewire across the mitral valve. Balloon inflation stretches the valve and reduces stenosis.