The Current Diagnosis and Treatment of high-risk Patients With Chronic Primary and Secondary Mitral Valve Regurgitation

Abstract

Mitral valve regurgitation (MR) is due primarily to either primary degeneration of the mitral valve with Barlow’s or fibroelastic disease or is secondary to ischemic or nonischemic cardiomyopathies. Echocardiography is essential to assess MR etiology and severity, the remodeling of cardiac chambers and to characterize longitudinal chamber changes to determine optimal therapies. Surgery is recommended for severe primary MR if persistent symptoms are present or if left ventricle dysfunction is present with an EF <60% or a left ventricle end-systolic diameter ≥40 mm. For secondary MR, therapy of heart failure with vasodilators and diuretics improves forward cardiac output. Coronary artery bypass grafts (CABG) or percutaneous coronary intervention (PCI) should be considered for severe MR due to ischemia. This review summarizes the pathophysiology, the characteristics, the management and the different interventions for high risk patients with chronic primary and secondary MR.

Keywords:

• Barlow’s disease
• cardiac magnetic resonance imaging
• echocardiography
• fibroelastic deficiency
• functional mitral regurgitation
• MitraClip
• mitral valve apparatus
• mitral valve repair
• mitral valve replacement
• primary mitral valve degeneration
• secondary mitral regurgitation
• transcatheter mitral valve replacement

Acknowledgments

The author thanks the librarians for their assistance in providing many of the articles cited in this manuscript. The author also thanks the Medical Media Departments of the University of South Florida/James A Haley Hospital for their assistance with the figures included in this manuscript and the Department of Cardiothoracic Surgery of the University of South Florida for the mitral valve pictures in Figure 2.

Financial & competing interests disclosure

Work in the cardiovascular research laboratory of the author is supported by a grant from the Cardiomyopathy Foundation. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.