Management-Oriented Classification of Mitral Valve Regurgitation

Table 1

Classification of and Current Indications for Intervention for Ischemic and Asymptomatic Degenerative MR.

	Phase 1; (Normal LV function and dimensions)	Phase 2; (Normal EF (≥50%) and ESD with indirect signs of LV Dysfunction*	Phase 3; (EF ≥30%–<50%  and/or mild to moderate LV dilatation “ESD > 40 mm–55 < mm”)	Phase 4; (EF < 30%  and/or severe LV dilatation “ESD ≥ 55 mm”)
Stage A Mild MR (ERO < 20 mm)	Class III for Ischemic and Degenerative MR	Class III for Ischemic and Degenerative MR	Class III for Ischemic and Degenerative MR	Class III for Ischemic and Degenerative MR
Stage B Moderate MR (ERO = 20–39 mm)	Class IIa for Ischemic and Class III for Degenerative MR	Class IIa for Ischemic, and Class III for Degenerative MR	Class IIa for Ischemic and Class III for Degenerative MR	Class IIa for Ischemic and Class III for Degenerative MR
Stage C Severe MR (ERO ≥ 40 mm)	Class I for Ischemic and IIb for Degenerative MR	Class I for Ischemic, and IIa for Degenerative MR	Class I for Ischemic and Degenerative MR	Class IIa for Ischemic and IIb for Degenerative MR

Please note:
¹Surgery for Ischemic MR is often combined with coronary revascularization.
²For indications of surgery in symptomatic degenerative MR and DCM please see text.
³Successful mitral repair is expected in >90% of asymptomatic severe MR referred for surgery.
*Indirect signs of LV decompensation may include recent-onset atrial fibrillation, pulmonary artery systolic pressure greater than 50 mmHg at rest or greater than 60 mmHg with exercise.