J Cardiovasc Ultrasound.  2012 Dec;20(4):165-171. 10.4250/jcu.2012.20.4.165.

Surgical Timing of Degenerative Mitral Regurgitation: What to Consider

• Dolor-Torres MC
• Ling LH

• KMID: 2177402
• DOI: http://doi.org/10.4250/jcu.2012.20.4.165

Abstract

Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.

Keyword

Mitral regurgitation; Degenerative; Surgical timing; Risk stratification

MeSH Terms

Atrial Fibrillation
Heart Valve Diseases
Humans
Hypertension, Pulmonary
Mitral Valve Insufficiency
Ventricular Dysfunction, Left

Figure

• 

  Fig. 1 Putative relation between strain and left ventricular (LV) geometry/preload in severe organic mitral regurgitation (MR). With advancing disease, LV end-diastolic volume (EDV) increases, while myocardial strain (ɛ) increases and later declines as LV dysfunction supervenes. The natural history of MR may therefore be characterized by a gradually decreasing ɛ/EDV ratio. To enhance graphical presentation, the ordinate scales for each parameter are not equivalent.

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