Surgical Intervention on the Mitral and Tricuspid Valves in Patients with Left Ventricular Dysfunction and Heart Failure
Patients with left ventricular dysfunction due to either an ischemic or non-ischemic etiology often present with mitral insufficiency, usually in the setting of a structurally normal valve. This “functional” mitral insufficiency has been previously described by Carpentier as Type III insufficiency whereby restricted leaflet motion during either diastole (IIIa) or systole (IIIb) renders the valve incompetent . The management of Type IIIb mitral insufficiency remains controversial and two recent trials sponsored by the NIH have only partially improved our understanding of the surgical management of this pathology [2, 3]. In addition, patients with left ventricular dysfunction and severe mitral insufficiency may also present with pulmonary hypertension and secondary tricuspid insufficiency. Again, the management of functional tricuspid insufficiency remains controversial [4, 5].
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