Donovan and Starling developed an algorithm to aid in the management of a patient with asymptomatic mitral regurgitation. This can help determine the appropriate time to consider surgery.
Parameters:
(1) number of clinical factors
(2) left ventricular ejection fraction
(3) end systolic dimension of the left ventricle
(4) feasability of valve repair
Clinical factors:
(1) age in years
(2) mean pulmonary artery pressure
(3) cardiac index in liters per minute per square meter BSA
(4) left ventricular end-diastolic pressure in mm Hg
(5) coronary artery disease
(6) history of atrial arrhythmias
|
Clinical Factor |
Finding |
Points |
|
age in years |
<= 60 years of age |
0 |
|
|
> 60 years of age |
1 |
|
mean pulmonary artery pressure |
<= 20 mm Hg |
0 |
|
|
> 20 mm Hg |
1 |
|
coronary artery disease |
absent |
0 |
|
|
present |
1 |
|
cardiac index |
> 2.0 liters per minute per sq m |
0 |
|
|
<= 2.0 liters per min per sq m |
1 |
|
left ventricular end diastolic pressure |
<= 12 mm Hg |
0 |
|
|
> 12 mm Hg |
1 |
|
history of atrial arrhythmias |
absent |
0 |
|
|
present |
1 |
number of clinical factors =
= SUM(points for all 6 factors)
|
Parameter |
Finding |
Points |
|
number of clinical factors |
0 |
0 |
|
|
1 |
1 |
|
|
>= 2 |
2 |
|
left ventricular ejection fraction |
> 65% |
0 |
|
|
60 - 65% |
1 |
|
|
< 60% |
2 |
|
left ventricular end systolic dimension in mm |
< 40 mm |
0 |
|
|
40 - 45 mm |
1 |
|
|
> 45 mm |
2 |
|
feasibility of valve repair |
none |
0 |
|
|
possible |
1 |
|
|
definite |
2 |
total decision points =
= SUM(points for the 4 parameters)
Interpretation:
• minimum total decision points: 0
• maximum total decision points: 8
|
Total Points |
Management Recommendation |
|
0 or 1 |
clinical and echocardiographic followup every 6-12 months |
|
2 |
clinical and echocardiographic followup at 6 months |
|
>= 3 |
proceed with surgery |
Specialty: Cardiology
ICD-10: ,
