NEJM -- Mitral Regurgitation Due to Degenerative Mitral-Valve Disease

Volume 363:156-165 July 8, 2010 Number 2

Mitral Regurgitation Due to Degenerative Mitral-Valve Disease

Elyse Foster, M.D.

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 44-year-old man presents with dyspnea and new atrial fibrillation. He received a diagnosis of mitral regurgitation at 28 years of age, after physical examination revealed a midsystolic click and late-systolic murmur; echocardiography performed at that time showed mitral-valve prolapse with mild late-systolic mitral regurgitation and normal left ventricular size and function. He has not seen a physician in many years. Physical examination reveals a holosystolic murmur and a soft S3 sound. Repeat echocardiography shows a flail posterior leaflet and moderately severe mitral regurgitation. How should this case be managed?

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NEJM -- Mitral Regurgitation Due to Degenerative Mitral-Valve Disease