Current Diagnosis and Therapeutic Approach of Functional Mitral Regurgitation
Abstract
Functional mitral regurgitation is characterized by normal structures of the mitral valve and chordae tendinea, but the regurgitation occurs due to geometric changes in the left atrium and left ventricle. This condition can contribute to heart failure progression and lead to a poor prognosis. Functional mitral regurgitation is found in approximately one-third of patients with heart failure with a decreased ejection fraction. Echocardiography is the primary work-up for assessing the anatomy and function of the left ventricle, mitral valve, and severity of functional mitral regurgitation. Additionally, for the latter, an integrated qualitative and quantitative assessment is essential to determine the optimal therapeutic strategy. According to the current guidelines, medical therapy remains the main treatment for functional mitral regurgitation. Yet, transcatheter intervention is a safe and effective treatment option in selected patients. While the effect of surgery on improving mortality in patients with functional mitral regurgitation is not established yet, recent guidelines recommend considering surgery for patients who have undergone coronary artery bypass surgery or other cardiac procedures.
Keywords
References
Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation. JASE. 2017:30(4):305-12.
Coats AJS, Anker SD, Baumbach A, et al. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J. 2021:42:1254-69.
Dziadzko V, Dziadzko M, Inojosa JRM, et al. Causes and mechanism of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J. 2019:40:2194-202.
Grayburn PA, Thomas JD. Basic principles of the echocardiographic evaluation of mitral regurgitation. JACC. 2021;14(4):843-53.
Beyersdorf F, Praz F, Milozevic M, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561-632.
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease. Circulation. 2021;143:e72-e227.
Almazini P, Hersunarti N, Soerarso R, Siswanto BS, Firman D, Soesanto AM. Early experience of mitra clip procedure at National Cardiovascular Center Harapan Kita, Jakarta. J Kardiol Indones. 2015:36:82-7.
Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J med. 2016;374:344-53.
Refbacks
- There are currently no refbacks.