| Primary MR (leaflet abnormality) | |
| - MVP myxomatous changes | - Prolapse, flail, ruptured or elongated chordae |
| - Degenerative changes | - Calcification, thickening |
| - Infectious | - Endocarditis vegetations, perforations, aneurysm |
| - Inflammatory | - Rheumatic, collagen vascular disease, radiation, drugs |
| - Congenital | - Cleft leaflet, parachute MV |
| Secondary MR (ventricular remodeling) | |
| - Ischemic etiology | - Artery disease |
| - Nonischemic cardiomyopathy: Annular dilation | - Atrial fibrillation, restrictive cardiomyopathy |
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