-
Clinical Cardiology Jun 1994This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. In Part I, conditions producing mitral valve... (Review)
Review
This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. In Part I, conditions producing mitral valve stenosis are reviewed. In over 99% of stenotic mitral valves, the etiology is rheumatic disease. Other rare causes of mitral stenosis include congenital malformed valves, active infective endocarditis, massive annular calcium, and metabolic or enzymatic abnormalities. In Part II, conditions producing pure mitral regurgitation will be discussed. In contrast to the few causes of mitral stenosis, the causes of pure (no element of stenosis) mitral regurgitation are multiple. Some of the conditions producing pure regurgitation include floppy mitral valves, infective endocarditis, papillary muscle dysfunction, rheumatic disease, and ruptured chordae tendinae.
Topics: Calcinosis; Catheterization; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Rheumatic Heart Disease; Rheumatic Nodule
PubMed: 8070151
DOI: 10.1002/clc.4960170611 -
Minerva Cardioangiologica Feb 2003Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 3/4 of the population. Pathologic mitral regurgitation is a common hospital... (Review)
Review
Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 3/4 of the population. Pathologic mitral regurgitation is a common hospital diagnosis, but the percent of patients with mitral valve disease who ever require surgical correction is very small. There are many etiologies of mitral regurgitation, caused by either pathologic changes to one or more of the components of the mitral valve, including the leaflets, annulus, chordae tendineae, papillary muscles, or by abnormalities of the surrounding left ventricle and/or atrium. Mitral regurgitation can be diagnosed on physical exam or by angiography, but is best diagnosed and quantified using echocardiography. The outcome of mitral regurgitation depends on the acuity of onset of the regurgitation, as well as etiology of the mitral valve disease. Acute mitral regurgitation requires urgent mitral valve surgery. In contrast, most patients with chronic mitral regurgitation will never need corrective surgery. Currently, there is not convincing evidence that medical therapy with vasodilating medications slows the progression of mitral regurgitation. When patients with chronic mitral regurgitation develop symptoms of pathologic changes to the left ventricle, surgical treatment should be offered. Mitral valve repair is the preferred corrective surgery, and only when not possible should mitral valve replacement be performed.
Topics: Cardiac Surgical Procedures; Humans; Mitral Valve Insufficiency
PubMed: 12652258
DOI: No ID Found -
The Journal of Thoracic and... Jun 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency
PubMed: 32008761
DOI: 10.1016/j.jtcvs.2019.12.053 -
JACC. Cardiovascular Imaging Feb 2022
Topics: Cardiomyopathies; Fibrosis; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 34656464
DOI: 10.1016/j.jcmg.2021.07.025 -
Circulation Journal : Official Journal... 2013Chronic ischemic mitral regurgitation (IMR) is still a significant clinical problem. It is present in 10-20% of patients with coronary artery disease and is associated... (Review)
Review
Chronic ischemic mitral regurgitation (IMR) is still a significant clinical problem. It is present in 10-20% of patients with coronary artery disease and is associated with a worse prognosis after myocardial infarction and subsequent revascularization. Currently, coronary artery bypass grafting combined with restrictive annuloplasty is the most commonly performed surgical procedure, although novel approaches have been used in limited numbers with varying degrees of success. The purpose of this review is to clarify the rationale for the surgical techniques applicable to IMR. In order to do so, the condition will be defined and the evolution of classic or traditional surgical approaches to repairing or replacing the mitral valve in the setting of IMR will be described. Finally, novel approaches to the repair of the ischemic mitral valve will be considered.
Topics: Chronic Disease; Coronary Artery Bypass; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Myocardial Ischemia
PubMed: 23877709
DOI: 10.1253/circj.cj-13-0743 -
JACC. Cardiovascular Imaging Jun 2022
Topics: Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Phenotype; Predictive Value of Tests
PubMed: 35680230
DOI: 10.1016/j.jcmg.2022.03.028 -
JACC. Cardiovascular Imaging May 2022
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Predictive Value of Tests
PubMed: 35131204
DOI: 10.1016/j.jcmg.2022.01.011 -
Journal of the American College of... Dec 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 34886962
DOI: 10.1016/j.jacc.2021.10.010 -
Journal of the American College of... Nov 2020
Topics: Acute Kidney Injury; Cardiac Surgical Procedures; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 33213726
DOI: 10.1016/j.jacc.2020.10.017 -
JACC. Cardiovascular Imaging Apr 2021This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR)...
OBJECTIVES
This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR) to primary mitral regurgitation (PMR).
BACKGROUND
AFMR remains poorly defined clinically.
METHODS
Consecutive patients who underwent transesophageal echocardiography at our institution between 2011 and 2018 for severe mitral regurgitation with preserved left ventricular function were screened. We excluded patients with endocarditis, any form of cardiomyopathy, or prior mitral intervention. The absence of leaflet pathology defined AFMR. Outcomes included death and heart failure hospitalizations.
RESULTS
A total of 283 patients were included (AFMR = 14%, PMR = 86%). Compared to PMR, patients with AFMR had more comorbidities, including hypertension (94.9% vs. 76.2%; p = 0.015), diabetes mellitus (46.2% vs. 18.4%; p < 0.001), long-standing atrial fibrillation (28.2% vs. 13.1%; p = 0.015), prior nonmitral cardiac surgery (25.6% vs. 9.8%; p = 0.004), and pacemaker placement (33.3% vs. 13.5%; p = 0.002). They also had higher average E/e' (median [interquartile range]:16.04 [13.1 to 22.46] vs. 14.1 [10.89 to 19]; p = 0.036) and worse longitudinal left atrial strain peak positive value (16.86 ± 12.15% vs. 23.67 ± 14.09%; p = 0.002) compared to PMR. During follow-up (median: 22 months), patients with AFMR had worse survival (log-rank p = 0.009) and more heart failure hospitalizations (log-rank p = 0.002). They were also less likely to undergo mitral valve intervention (59.0% vs. 83.6%; p = 0.001), although surgery was associated with improved survival (log-rank p = 0.021). On multivariable regression analysis, AFMR was independently associated with mortality [adjusted odds ratio: 2.61, 95% confidence interval: 1.17 to 5.83; p = 0.02].
CONCLUSIONS
AFMR constitutes an under-recognized high-risk group, with significant comorbidities, limited therapeutic options, and poor outcomes.
Topics: Echocardiography; Heart Atria; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 33832663
DOI: 10.1016/j.jcmg.2021.02.008