Functional mitral regurgitation: therapeutic strategies for a ventricular disease

Functional mitral regurgitation is a highly prevalent condition among patients with ischemic and dilated cardiomyopathies. Arising from remodeling of both the mitral valve annulus and the left ventricle, it is associated with high mortality and morbidity. In selected patients, cardiac resynchronization therapy helps to reduce functional mitral regurgitation, but surgical intervention remains the mainstay of therapy when medical therapy for left ventricular dysfunction has been inadequate. It is, however, associated with significant perioperative risks and does not alter long-term mortality. Percutaneous devices, and more recently the Mitraclip in particular, represent a promising alternative that can improve symptoms and ventricular remodeling with significantly lower periprocedural risk.