Skip to main content

Assessment and Timing to Intervention of Mitral Regurgitation

  • Chapter
  • First Online:
Cardiac Valvular Medicine

Abstract

There is no doubt about the fact that mitral regurgitation (MR) is one of the most frequent and challenging diagnosis in daily work in any echocardiography lab. Chronic organic MR, due to increasing prevalence of myxomatous disease and the increasing mean age of population, is presenting as often as aortic stenosis: moderate or severe MR is found in 1.7% of the general population and in up to 9.3% of those over 75 years (Iung and Vahanian 2011). Echocardiography is the main tool for MR evaluation. In the modern times of mitral valve (MV) repair surgery, echocardiography has become even more important because the study has to cover not only the MR diagnosis, but the evaluation of the valvular lesions and the mechanisms of disease to guide the election between the different therapeutic options. This combination of aspects related to the complexity of mitral regurgitation is the primary driving force to develop an all encompassing assessment of MR to allow the clinician and surgeon to achieve the superior clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Bonow RO, Carabello BA, Kanu C, de Leon Jr AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith Jr SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006a;114(5):e84–231.

    Article  PubMed  Google Scholar 

  • Bonow RO, Carabello BA, Chatterjee K, de Leon Jr AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith Jr SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006b;48(3):e1–148.

    Article  PubMed  Google Scholar 

  • Bridgewater B, Hooper T, Munsch C, Hunter S, von Oppell U, Livesey S, Keogh B, Wells F, Patrick M, Kneeshaw J, Chambers J, Masani N, Ray S. Mitral repair best practice: proposed standards. Heart (Br Cardiac Soc). 2006;92(7):939–44.

    Article  CAS  Google Scholar 

  • Caira FC, Stock SR, Gleason TG, McGee EC, Huang J, Bonow RO, Spelsberg TC, McCarthy PM, Rahimtoola SH, Rajamannan NM. Human degenerative valve disease is associated with up-regulation of low-density lipoprotein receptor-related protein 5 receptor-mediated bone formation. J Am Coll Cardiol. 2006;47(8):1707–12.

    Article  PubMed  CAS  Google Scholar 

  • Carpentier A, Adams DH, Filsoufi F. Carpentier’s reconstructive valve surgery. Maryland heights. Saunders-Elsevier; Riverport Lane, USA 2010.

    Google Scholar 

  • Castillo JG, Solis J, Gonzalez-Pinto A, Adams DH. Surgical echocardiography of the mitral valve. Rev Esp Cardiol. 2011;64(12):1169–81.

    Article  PubMed  Google Scholar 

  • Chenot F, Montant P, Vancraeynest D, Pasquet A, Gerber B, Noirhomme PH, El Khoury G, Vanoverschelde JL. Long-term clinical outcome of mitral valve repair in asymptomatic severe mitral regurgitation. Eur J Cardiothorac Surg. 2009;36(3):539–45.

    Article  PubMed  Google Scholar 

  • Enriquez-Sarano M, Sundt 3rd TM. Early surgery is recommended for mitral regurgitation. Circulation. 2010;121(6):804–11; discussion 812.

    Article  PubMed  Google Scholar 

  • Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352(9):875–83.

    Article  PubMed  CAS  Google Scholar 

  • Grigioni F, Tribouilloy C, Avierinos JF, Barbieri A, Ferlito M, Trojette F, Tafanelli L, Branzi A, Szymanski C, Habib G, Modena MG, Enriquez-Sarano M. Outcomes in mitral regurgitation due to flail leaflets a multicenter European study. JACC Cardiovasc Imaging. 2008;1(2):133–41.

    Article  PubMed  Google Scholar 

  • Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev. 2011;8(3):162–72.

    Google Scholar 

  • Kang DH, Kim JH, Rim JH, Kim MJ, Yun SC, Song JM, Song H, Choi KJ, Song JK, Lee JW. Comparison of early surgery versus conventional treatment in asymptomatic severe mitral regurgitation. Circulation. 2009;119(6):797–804.

    Article  PubMed  Google Scholar 

  • Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(4):307–32.

    Article  PubMed  Google Scholar 

  • Lancellotti P, Magne J, O’Connor K, Pierard LA. Mitral valve disease. The EAE textbook of echocardiography. Oxford University Press; New York, USA 2011.

    Google Scholar 

  • Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996;335(19):1417–23.

    Article  PubMed  CAS  Google Scholar 

  • Ling LH, Enriquez-Sarano M, Seward JB, Orszulak TA, Schaff HV, Bailey KR, Tajik AJ, Frye RL. Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study. Circulation. 1997;96(6):1819–25.

    Article  PubMed  CAS  Google Scholar 

  • Michelena HI, Bichara VM, Margaryan E, Forde I, Topilsky Y, Suri R, Enriquez-Sarano M. Progress in the treatment of severe mitral regurgitation. Rev Esp Cardiol. 2010;63(7):820–31.

    Article  PubMed  Google Scholar 

  • Montant P, Chenot F, Robert A, Vancraeynest D, Pasquet A, Gerber B, Noirhomme P, El Khoury G, Vanoverschelde JL. Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: a propensity score-based comparison between an early surgical strategy and a conservative treatment approach. J Thorac Cardiovasc Surg. 2009;138(6):1339–48.

    Article  PubMed  Google Scholar 

  • Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H. Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation. 2006;113(18):2238–44.

    Article  PubMed  Google Scholar 

  • Tietge WJ, de Heer LM, van Hessen MW, Jansen R, Bots ML, van Gilst W, Schalij M, Klautz RJ, Van den Brink RB, Van Herwerden LA, Doevendans PA, Chamuleau SA, Kluin J. Early mitral valve repair versus watchful waiting in patients with severe asymptomatic organic mitral regurgitation; rationale and design of the Dutch AMR trial, a multicenter, randomised trial. Neth Heart J. 2012;20(3):94–101.

    Article  PubMed  CAS  Google Scholar 

  • Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A. Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J. 2007;28(2):230–68.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to José Juan Gómez de Diego M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

de Diego, J.J.G., Rajamannan, N.M. (2013). Assessment and Timing to Intervention of Mitral Regurgitation. In: Rajamannan, N. (eds) Cardiac Valvular Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-4132-7_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4132-7_16

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4131-0

  • Online ISBN: 978-1-4471-4132-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics