Functional mitral regurgitation: current understanding and approach to management

Functional mitral regurgitation (FMR) is a challenging clinical entity that frequently complicates ischemic and nonischemic cardiomyopathy. The underlying pathophysiology of FMR is caused primarily by ventricular and subvalvular apparatus dysfunction which causes failure of proper leaflet coaptation. Echocardiography is the primary modality used in diagnosis and characterization of FMR. Echocardiography allows for assessment of valvular and ventricular structures and their interaction. FMR portends a poor prognosis, because it is frequently associated with increased morbidity and mortality. The optimal management of FMR involves an individualized approach that incorporates medical therapy and consideration of surgical, percutaneous, and resynchronization therapies according to the severity of regurgitation, presence of symptoms, option for revascularization, and the degree of ventricular remodelling.