Enriquez-Sarano et al identified a number of factors affecting survival in patients with asymptomatic, isolated mitral regurgitation. These can help identify patients who may benefit from more aggressive management. The authors are from the Mayo Clinic.


The effective regurgitation orifice (EFO) was determined using quantitative two-dimensional echocardiography.


Risk factors associated with worse outcomes (see page 878):

(1) younger age

(2) absence of diabetes mellitus

(3) higher effective regurgitation orifice (EFO) for the mitral valve (reflecting more severe regurgitation)

(4) not performing cardiac surgery if indicated


EFO in square mm

Severity of Mitral Regurgitation

Rate of Cardiac Events at 5 Years

< 20



20 - 39



>= 40



from Figure 3, page 881


Cardiac surgery was associated with a higher rate of new atrial fibrillation but a decreased risk for congestive heart failure. It was associated with a significant improvement in survival for patients with severe mitral regurgitation.


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