Mitral valve regurgitation

Abstract

The prevalence of mitral regurgitation (MR) is increasing in Western countries, which results in making it the second most frequent valvular heart disease requiring surgery. MR can be classified as primary (organic) or secondary (functional). Causes of primary MR consist of leaflet lesions, either degenerative changes (Barlow’s disease, fibroelastic degeneration, and annular calcification), rheumatic disease, or infective endocarditis. Causes of secondary MR consist of those that produce geometrical distortion of the subvalvular apparatus due to dilatation and remodelling of the left ventricle such as ischaemic heart disease and cardiomyopathies. The implementation of mitral valve repair as well as the rise of new transcatheter techniques, provided that are performed in experienced, high volume centres with the contribution of a valvular heart team, have impressively changed the prognosis of patients with severe MR. This has set new frontiers in the management of MR and has upgraded the role of imaging, creating new responsibilities, since its presence in every step of the procedure either preoperatively (quantification of MR, determination of the underlying mechanisms, investigation of reparability, determination of prognosis) or intra- and postoperatively, has been declared as fundamental.