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Surgery for severe mitral regurgitation and left ventricular failure: what do we really know?
Mandeep R Mehra1, Peter Reyes, R Michael Benitez
1Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
Journal of Cardiac Failure
|March 8, 2008
Summary
Functional mitral regurgitation (MR) in cardiomyopathy stems from ventricular changes affecting a normal mitral valve. Surgical repair shows promise for improving symptoms and heart remodeling, but survival benefits require further study.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure
Background:
- Functional mitral regurgitation (MR) in cardiomyopathy arises from ventricular geometric abnormalities, not primary valve disease.
- Left ventricular enlargement leads to annular dilation, increased papillary muscle distance, and leaflet tethering, impairing mitral valve coaptation.
Observation:
- Morphologically normal mitral valve leaflets fail to coapt due to ventricular remodeling in ischemic and nonischemic cardiomyopathy.
- Pharmacologic therapy and cardiac resynchronization therapy can positively influence these geometric abnormalities.
Findings:
- Surgical repair using an undersized rigid annuloplasty ring can eliminate functional MR.
- This surgical approach is linked to enhanced functional status and improved left ventricular remodeling.
Implications:
- While surgery improves functional outcomes, its impact on survival in functional MR requires further investigation.
- Prospective randomized clinical trials are crucial to definitively assess the benefits of surgical repair for functional geometric MR.
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