Functional Classification of Secondary Mitral Valve Regurgitation

  • Luigi Paolo Badano
  • Sorina Mihaila
  • Denisa Muraru
  • Dragos Vinereanu
  • Sabino Iliceto


Secondary mitral regurgitation (SMR) is defined as an insufficiency of the mitral valve, due to an abnormal function of normal valve leaflets, related to impaired left ventricular (LV) function (Lancellotti et al., Eur J Echocardiogr 11(4):307–32, 2010). Some authors consider it to be a ventricular disease with a “valvular phenotype” (Komeda et al., Circ J 73(Suppl A):A23–8, 2009).

SMR can be caused either by ischemic heart disease (with or without LV dilatation), or non-ischemic dilated cardiomiopathy (Marwick et al., Heart 95(20):1711–8, 2009). It has also been described in patients with right ventricular pacing, due to secondary LV dyssynchrony (Barold and Ovsyshcher, Pacing Clin Electrophysiol 28(5):357–60, 2005), or on maintenance dialysis due to end-stage chronic kidney disease (Cirit et al., Nephrol Dial Transplant 13(2):389–92, 1998). Therefore, SMR can result from a heterogeneous group of etiologies, with particular aspects regarding pathophysiology, clinical presentation, and prognosis.

After a myocardial infarction, SMR has been reported to occur with an incidence ranging from 20–25 % (Lamas et al., Circulation 96(3):827–33, 1997) up to 40–50 % of patients, (Bursi et al., Circulation 111(3):295–301, 2005; Perezde Isla et al., Eur Heart J 27(22):2655–60, 2006). Despite the fact that SMR has an independent adverse prognostic value, even when the severity is only mild and there are no signs of congestive heart failure (Lamas et al., Circulation 96(3):827–33, 1997; Lancellotti et al., Circulation 108(14):1713–7, 2003; St John Sutton et al., Circulation 96(10):3294–9, 1997; Agricola et al., J Am Soc Echocardiogr 24(12):1376–82, 2011), morbidity and mortality are related to SMR severity (Grigioni et al., Circulation 103(13):1759–64, 2001; Amigoni et al., Eur Heart J 28(3):326–33, 2007).

Progressive LV remodeling encountered in dilated cardiomiopathy, independent on its etiology, leads to SMR despite anatomically normal mitral valve leaflets (Yiu et al., Circulation 102(12):1400–6, 2000; Trichon et al., Circulation 108(Suppl 1):II103–10, 2003). In these patients, SMR is a multifactorial condition (Donal et al., Eur J Echocardiogr 10(1):133–8, 2009) associated with poor hemodynamics and adverse clinical prognosis (Grigioni et al., Circulation 103(13):1759–64, 2001; Robbins et al., Am J Cardiol 91(3):360–2, 2003).

The pathophysiology of SMR is at present quite well established, and particular clinical interest is directed towards finding a tailored therapeutic strategy for each particular case (Anyanwu et al., Curr Treat Options Cardiovasc Med 10(6):529–37, 2008). Therefore, it is generally recommended a comprehensive assessment of the mechanism of SMR and its classification before planning the surgical intervention, in order to tailor it on the specific characteristics of each patient. However, despite the multitude of therapeutic strategies developed to correct SMR (Fattouch et al., J Thorac Cardiovasc Surg 138(2):278–85, 2009; Fattouch et al., J Thorac Cardiovasc Surg 143(4 Suppl):S38–42, 2012; Fattouch et al., J Thorac Cardiovasc Surg 143(6):1352–5, 2012; Vassileva et al., Eur J Cardiothorac Surgery 39(3):295–303, 2011; Magne et al., J Am Coll Cardiol 51(17):1692–701, 2008; Braun et al., Ann Thorac Surg 85(2):430–6, 2008), post-intervention recurrence of MR still has a high incidence (Magne et al., Circulation 120(11 Suppl):S104–11, 2009).


Mitral Valve Papillary Muscle Left Ventricular Remodel Mitral Leaflet Left Ventricular Dyssynchrony 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, et al. 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.PubMedCrossRefGoogle Scholar
  2. 2.
    Carpentier A. Cardiac valve surgery–the “French correction”. J Thorac Cardiovasc Surg. 1983;86(3):323–37. PubMed PMID: 6887954. Epub 1983/09/01. eng.PubMedGoogle Scholar
  3. 3.
    Filsoufi F, Rahmanian PB, Anyanwu A, Adams DH. Physiologic basis for the surgical treatment of ischemic mitral regurgitation. Am Heart Hosp J. 2006;4(4):261–8. PubMed PMID: 17086006. Epub 2006/11/07. eng.PubMedCrossRefGoogle Scholar
  4. 4.
    Boltwood CM, Tei C, Wong M, Shah PM. Quantitative echocardiography of the mitral complex in dilated cardiomyopathy: the mechanism of functional mitral regurgitation. Circulation. 1983;68(3):498–508. PubMed PMID: 6872163. Epub 1983/09/01. eng.PubMedCrossRefGoogle Scholar
  5. 5.
    Karaca O, Avci A, Guler GB, Alizade E, Guler E, Gecmen C, et al. Tenting area reflects disease severity and prognosis in patients with non-ischaemic dilated cardiomyopathy and functional mitral regurgitation. Eur J Heart Fail. 2011;13(3):284–91. PubMed PMID: 21106544. Epub 2010/11/26. eng.PubMedCrossRefGoogle Scholar
  6. 6.
    Hueb AC, Jatene FB, Moreira LF, Pomerantzeff PM, Kallas E, de Oliveira SA. Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: new insights from anatomic study. J Thorac Cardiovasc Surg. 2002;124(6):1216–24. PubMed PMID: 12447190. Epub 2002/11/26. eng.PubMedCrossRefGoogle Scholar
  7. 7.
    Salgo IS, Gorman 3rd JH, Gorman RC, Jackson BM, Bowen FW, Plappert T, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation. 2002;106(6):711–7. PubMed PMID: 12163432. Epub 2002/08/07. eng.PubMedCrossRefGoogle Scholar
  8. 8.
    Ormiston JA, Shah PM, Tei C, Wong M. Size and motion of the mitral valve annulus in man. I. A two-dimensional echocardiographic method and findings in normal subjects. Circulation. 1981;64(1):113–20. PubMed PMID: 7237707. Epub 1981/07/01. eng.PubMedCrossRefGoogle Scholar
  9. 9.
    Kwan J, Jeon MJ, Kim DH, Park KS, Lee WH. Does the mitral annulus shrink or enlarge during systole? A real-time 3D echocardiography study. J Korean Med Sci. 2009;24(2):203–8. PubMed PMID: 19399259. Pubmed Central PMCID: 2672117. Epub 2009/04/29. eng.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Tibayan FA, Rodriguez F, Zasio MK, Bailey L, Liang D, Daughters GT, et al. Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation. 2003;108 Suppl 1:II116–21. PubMed PMID: 12970219. Epub 2003/09/13. eng.PubMedGoogle Scholar
  11. 11.
    Silbiger JJ. Mechanistic insights into ischemic mitral regurgitation: echocardiographic and surgical implications. J Am Soc Echocardiogr. 2011;24(7):707–19. PubMed PMID: 21592725. Epub 2011/05/20. eng.PubMedCrossRefGoogle Scholar
  12. 12.
    De Simone R, Wolf I, Mottl-Link S, Hoda R, Mikhail B, Sack FU, et al. A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty. Eur J Cardiothorac Surg. 2006;29(3):355–61. PubMed PMID: 16439153. Epub 2006/01/28. eng.PubMedCrossRefGoogle Scholar
  13. 13.
    Khabbaz KR, Mahmood F, Shakil O, Warraich HJ, Gorman 3rd JH, Gorman RC, et al. Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation. Ann Thorac Surg. 2013;95(1):105–10. PubMed PMID: 23103005. Epub 2012/10/30. eng.PubMedCrossRefGoogle Scholar
  14. 14.
    Pierard LA, Carabello BA. Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment. Eur Heart J. 2010;31(24):2996–3005. PubMed PMID: 21123277. Epub 2010/12/03. eng.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaplan SR, Bashein G, Sheehan FH, Legget ME, Munt B, Li XN, et al. Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve. Am Heart J. 2000;139(3):378–87. PubMed PMID: 10689248. Epub 2000/02/26. eng.PubMedCrossRefGoogle Scholar
  16. 16.
    Ahmad RM, Gillinov AM, McCarthy PM, Blackstone EH, Apperson-Hansen C, Qin JX, et al. Annular geometry and motion in human ischemic mitral regurgitation: novel assessment with three-dimensional echocardiography and computer reconstruction. Ann Thorac Surg. 2004;78(6):2063–8; discussion 8. PubMed PMID: 15561036. Epub 2004/11/25. eng.PubMedCrossRefGoogle Scholar
  17. 17.
    Zhu F, Otsuji Y, Yotsumoto G, Yuasa T, Ueno T, Yu B, et al. Mechanism of persistent ischemic mitral regurgitation after annuloplasty: importance of augmented posterior mitral leaflet tethering. Circulation. 2005;112(9 Suppl):I396–401. PubMed PMID: 16159853. Epub 2005/09/15. eng.PubMedGoogle Scholar
  18. 18.
    Topilsky Y, Vaturi O, Watanabe N, Bichara V, Nkomo VT, Michelena H, et al. Real-time 3-dimensional dynamics of functional mitral regurgitation: a prospective quantitative and mechanistic study. J Am Heart Assoc. 2013;2(3):e000039. PubMed PMID: 23727698. Epub 2013/06/04. eng.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Daimon M, Saracino G, Gillinov AM, Koyama Y, Fukuda S, Kwan J, et al. Local dysfunction and asymmetrical deformation of mitral annular geometry in ischemic mitral regurgitation: a novel computerized 3D echocardiographic analysis. Echocardiography. 2008;25(4):414–23. PubMed PMID: 18177391. Epub 2008/01/08. eng.PubMedCrossRefGoogle Scholar
  20. 20.
    Otsuji Y, Kumanohoso T, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol. 2002;39(10):1651–6. PubMed PMID: 12020493. Epub 2002/05/22. eng.PubMedCrossRefGoogle Scholar
  21. 21.
    Perloff JK, Roberts WC. The mitral apparatus. Functional anatomy of mitral regurgitation. Circulation. 1972;46(2):227–39. PubMed PMID: 5046018. Epub 1972/08/01. eng.PubMedCrossRefGoogle Scholar
  22. 22.
    Miller DC. Ischemic mitral regurgitation redux–to repair or to replace? J Thorac Cardiovasc Surg. 2001;122(6):1059–62. PubMed PMID: 11726880. Epub 2001/12/01. eng.PubMedCrossRefGoogle Scholar
  23. 23.
    Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2001;122(6):1125–41. PubMed PMID: 11726887. Epub 2001/12/01. eng.PubMedCrossRefGoogle Scholar
  24. 24.
    Wei JY, Hutchins GM, Bulkley BH. Papillary muscle rupture in fatal acute myocardial infarction: a potentially treatable form of cardiogenic shock. Ann Intern Med. 1979;90(2):149–52. PubMed PMID: 443647. Epub 1979/02/01. eng.PubMedCrossRefGoogle Scholar
  25. 25.
    Bursi F, Enriquez-Sarano M, Jacobsen SJ, Roger VL. Mitral regurgitation after myocardial infarction: a review. Am J Med. 2006;119(2):103–12. PubMed PMID: 16443408. Epub 2006/01/31. eng.PubMedCrossRefGoogle Scholar
  26. 26.
    Izumi S, Miyatake K, Beppu S, Park YD, Nagata S, Kinoshita N, et al. Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography. Circulation. 1987;76(4):777–85. PubMed PMID: 3652421. Epub 1987/10/01. eng.PubMedCrossRefGoogle Scholar
  27. 27.
    Leor J, Feinberg MS, Vered Z, Hod H, Kaplinsky E, Goldbourt U, et al. Effect of thrombolytic therapy on the evolution of significant mitral regurgitation in patients with a first inferior myocardial infarction. J Am Coll Cardiol. 1993;21(7):1661–6. PubMed PMID: 8496534. Epub 1993/06/01. eng.PubMedCrossRefGoogle Scholar
  28. 28.
    Kumanohoso T, Otsuji Y, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg. 2003;125(1):135–43. PubMed PMID: 12538997. Epub 2003/01/23. eng.PubMedCrossRefGoogle Scholar
  29. 29.
    Burch GE, De Pasquale NP, Phillips JH. Clinical manifestations of papillary muscle dysfunction. Arch Intern Med. 1963;112:112–7. PubMed PMID: 14016880. Epub 1963/07/01. eng.PubMedCrossRefGoogle Scholar
  30. 30.
    Burch GE, DePasquale NP, Phillips JH. The syndrome of papillary muscle dysfunction. Am Heart J. 1968;75(3):399–415. PubMed PMID: 4230184. Epub 1968/03/01. eng.PubMedCrossRefGoogle Scholar
  31. 31.
    Burch GE, DePasquale N, Phillips JH. The papillary muscle syndrome. JAMA. 1968;204(3):249–52. PubMed PMID: 5694559. Epub 1968/04/15. eng.PubMedCrossRefGoogle Scholar
  32. 32.
    Kaul S, Spotnitz WD, Glasheen WP, Touchstone DA. Mechanism of ischemic mitral regurgitation. An experimental evaluation. Circulation. 1991;84(5):2167–80. PubMed PMID: 1934385. Epub 1991/11/01. eng.PubMedCrossRefGoogle Scholar
  33. 33.
    Messas E, Guerrero JL, Handschumacher MD, Chow CM, Sullivan S, Schwammenthal E, et al. Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction: insights from three-dimensional and contrast echocardiography with strain rate measurement. Circulation. 2001;104(16):1952–7. PubMed PMID: 11602500. Epub 2001/10/17. eng.PubMedCrossRefGoogle Scholar
  34. 34.
    He S, Fontaine AA, Schwammenthal E, Yoganathan AP, Levine RA. Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies. Circulation. 1997;96(6):1826–34. PubMed PMID: 9323068. Epub 1997/10/10. eng.PubMedCrossRefGoogle Scholar
  35. 35.
    Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study. Circulation. 2000;102(12):1400–6. PubMed PMID: 10993859. Epub 2000/09/20. eng.PubMedCrossRefGoogle Scholar
  36. 36.
    Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LE, Gorcsan 3rd J. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping. J Am Coll Cardiol. 2004;44(8):1619–25. PubMed PMID: 15489094. Epub 2004/10/19. eng.PubMedCrossRefGoogle Scholar
  37. 37.
    Ennezat PV, Marechaux S, Le Tourneau T, Lamblin N, Bauters C, Van Belle E, et al. Myocardial asynchronism is a determinant of changes in functional mitral regurgitation severity during dynamic exercise in patients with chronic heart failure due to severe left ventricular systolic dysfunction. Eur Heart J. 2006;27(6):679–83. PubMed PMID: 16361325. Epub 2005/12/20. eng.PubMedCrossRefGoogle Scholar
  38. 38.
    Ennezat PV, Gal B, Kouakam C, Marquie C, LeTourneau T, Klug D, et al. Cardiac resynchronisation therapy reduces functional mitral regurgitation during dynamic exercise in patients with chronic heart failure: an acute echocardiographic study. Heart. 2006;92(8):1091–5. PubMed PMID: 16387811. Pubmed Central PMCID: 1861095. Epub 2006/01/03. eng.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Pierard LA, Lancellotti P. Left ventricular dyssynchrony and dynamic functional mitral regurgitation: relationship or association? Eur Heart J. 2006;27(6):638–40. PubMed PMID: 16431872. Epub 2006/01/25. eng.PubMedCrossRefGoogle Scholar
  40. 40.
    Lancellotti P, Stainier PY, Lebois F, Pierard LA. Effect of dynamic left ventricular dyssynchrony on dynamic mitral regurgitation in patients with heart failure due to coronary artery disease. Am J Cardiol. 2005;96(9):1304–7. PubMed PMID: 16253603. Epub 2005/10/29. eng.PubMedCrossRefGoogle Scholar
  41. 41.
    Breithardt OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A, et al. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol. 2003;41(5):765–70. PubMed PMID: 12628720. Epub 2003/03/12. eng.PubMedCrossRefGoogle Scholar
  42. 42.
    Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–53. PubMed PMID: 12063368. Epub 2002/06/14. eng.PubMedCrossRefGoogle Scholar
  43. 43.
    van Bommel RJ, Marsan NA, Delgado V, Borleffs CJ, van Rijnsoever EP, Schalij MJ, et al. Cardiac resynchronization therapy as a therapeutic option in patients with moderate-severe functional mitral regurgitation and high operative risk. Circulation. 2011;124(8):912–9. PubMed PMID: 21810666. Epub 2011/08/04. eng.PubMedCrossRefGoogle Scholar
  44. 44.
    Solis J, McCarty D, Levine RA, Handschumacher MD, Fernandez-Friera L, Chen-Tournoux A, et al. Mechanism of decrease in mitral regurgitation after cardiac resynchronization therapy: optimization of the force-balance relationship. Circ Cardiovasc Imaging. 2009;2(6):444–50. PubMed PMID: 19920042. Pubmed Central PMCID: 2821680. Epub 2009/11/19. eng.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Lancellotti P, Melon P, Sakalihasan N, Waleffe A, Dubois C, Bertholet M, et al. Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure. Am J Cardiol. 2004;94(11):1462–5. PubMed PMID: 15566929. Epub 2004/11/30. eng.PubMedCrossRefGoogle Scholar
  46. 46.
    Brandt RR, Reiner C, Arnold R, Sperzel J, Pitschner HF, Hamm CW. Contractile response and mitral regurgitation after temporary interruption of long-term cardiac resynchronization therapy. Eur Heart J. 2006;27(2):187–92. PubMed PMID: 16223745. Epub 2005/10/15. eng.PubMedCrossRefGoogle Scholar
  47. 47.
    Otsuji Y, Handschumacher MD, Schwammenthal E, Jiang L, Song JK, Guerrero JL, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation. 1997;96(6):1999–2008. PubMed PMID: 9323092. Epub 1997/10/10. eng.PubMedCrossRefGoogle Scholar
  48. 48.
    Watanabe N, Ogasawara Y, Yamaura Y, Kawamoto T, Toyota E, Akasaka T, et al. Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography. J Am Coll Cardiol. 2005;45(5):763–9. PubMed PMID: 15734623. Epub 2005/03/01. eng.PubMedCrossRefGoogle Scholar
  49. 49.
    Srichai MB, Grimm RA, Stillman AE, Gillinov AM, Rodriguez LL, Lieber ML, et al. Ischemic mitral regurgitation: impact of the left ventricle and mitral valve in patients with left ventricular systolic dysfunction. Ann Thorac Surg. 2005;80(1):170–8. PubMed PMID: 15975362. Epub 2005/06/25. eng.PubMedCrossRefGoogle Scholar
  50. 50.
    Sadeghpour A, Abtahi F, Kiavar M, Esmaeilzadeh M, Samiei N, Ojaghi SZ, et al. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation. J Cardiothorac Surg. 2008;3:54. PubMed PMID: 18840276. Pubmed Central PMCID: 2572601. Epub 2008/10/09. eng.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Magne J, Pibarot P, Dumesnil JG, Senechal M. Continued global left ventricular remodeling is not the sole mechanism responsible for the late recurrence of ischemic mitral regurgitation after restrictive annuloplasty. J Am Soc Echocardiogr. 2009;22(11):1256–64. PubMed PMID: 19815380. Epub 2009/10/10. eng.PubMedCrossRefGoogle Scholar
  52. 52.
    Matsunaga A, Tahta SA, Duran CM. Failure of reduction annuloplasty for functional ischemic mitral regurgitation. J Heart Valve Dis. 2004;13(3):390–7; discussion 7–8. PubMed PMID: 15222285. Epub 2004/06/30. eng.PubMedGoogle Scholar
  53. 53.
    Hung J, Papakostas L, Tahta SA, Hardy BG, Bollen BA, Duran CM, et al. Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target. Circulation. 2004;110(11 Suppl 1):II85–90. PubMed PMID: 15364844. Epub 2004/09/15. eng.PubMedGoogle Scholar
  54. 54.
    Agricola E, Oppizzi M, Maisano F, De Bonis M, Schinkel AF, Torracca L, et al. Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern. Eur J Echocardiogr. 2004;5(5):326–34. PubMed PMID: 15341868. Epub 2004/09/03. eng.PubMedCrossRefGoogle Scholar
  55. 55.
    Nagasaki M, Nishimura S, Ohtaki E, Kasegawa H, Matsumura T, Nagayama M, et al. The echocardiographic determinants of functional mitral regurgitation differ in ischemic and non-ischemic cardiomyopathy. Int J Cardiol. 2006;108(2):171–6. PubMed PMID: 15916824. Epub 2005/05/27. eng.PubMedCrossRefGoogle Scholar
  56. 56.
    Papadopoulou K, Giannakoulas G, Karvounis H, Dalamanga E, Karamitsos T, Parcharidou D, et al. Differences in echocardiographic characteristics of functional mitral regurgitation in ischaemic versus idiopathic dilated cardiomyopathy: a pilot study. Hellenic J Cardiol. 2009;50(1):37–44. PubMed PMID: 19196619. Epub 2009/02/07. eng.PubMedGoogle Scholar
  57. 57.
    de Varennes B, Chaturvedi R, Sidhu S, Cote AV, Shan WL, Goyer C, et al. Initial results of posterior leaflet extension for severe type IIIb ischemic mitral regurgitation. Circulation. 2009;119(21):2837–43. PubMed PMID: 19451349. Epub 2009/05/20. eng.PubMedCrossRefGoogle Scholar
  58. 58.
    De Bonis M, Alfieri O. Mitral regurgitation should be corrected in patients with dilated cardiomyopathy. Nat Clin Pract Cardiovasc Med. 2008;5(8):452–3. PubMed PMID: 18560405. Epub 2008/06/19. eng.PubMedCrossRefGoogle Scholar
  59. 59.
    Braun J, van de Veire NR, Klautz RJ, Versteegh MI, Holman ER, Westenberg JJ, et al. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg. 2008;85(2):430–6; discussion 6–7. PubMed PMID: 18222238. Epub 2008/01/29. eng.PubMedCrossRefGoogle Scholar
  60. 60.
    Fundaro P, Pocar M, Donatelli F, Grossi A. Chronic ischemic mitral regurgitation: types and subtypes. J Thorac Cardiovasc Surg. 2002;124(4):855–6; author reply 6. PubMed PMID: 12324752. Epub 2002/09/27. eng.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Luigi Paolo Badano
    • 1
  • Sorina Mihaila
    • 2
    • 3
  • Denisa Muraru
    • 1
  • Dragos Vinereanu
    • 4
  • Sabino Iliceto
    • 1
  1. 1.Department of Cardiac, Thoracic and Vascular SciencesUniversity of PaduaPaduaItaly
  2. 2.Department of Cradiology, Thoracic and Vascular SciencesUniversity of PaduaPaduaItaly
  3. 3.University of Medicine and Pharmacy “Carol Davila”BucharestRomania
  4. 4.Department of CradiologyUniversity of Medicine and Pharmacy “Carol Davila”BucharestRomania

Personalised recommendations