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Management of organic mitral regurgitation: guideline recommendations and controversies.

Gurzun MM, Popescu AC, Ginghina C, Popescu BA - Korean Circ J (2015)

Bottom Line: The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair.Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed.Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.

ABSTRACT
Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.

No MeSH data available.


Related in: MedlinePlus

Mitral valve reconstruction in a normal subject (A) and in a patient with severe mitral regurgitation due to P2 scallop flail and prolapse and P3 scallop prolapse (B). The parts of the mitral valve which are below the mitral annulus plane (i.e., on the ventricular side) are color-coded in blue, while the parts which are above annulus are coded in red. Of note, the shape of the mitral annulus changes in MR, becoming circular (B), compared to the oval shape of the normal mitral annulus (A). MR: metral regurgitation.
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Figure 3: Mitral valve reconstruction in a normal subject (A) and in a patient with severe mitral regurgitation due to P2 scallop flail and prolapse and P3 scallop prolapse (B). The parts of the mitral valve which are below the mitral annulus plane (i.e., on the ventricular side) are color-coded in blue, while the parts which are above annulus are coded in red. Of note, the shape of the mitral annulus changes in MR, becoming circular (B), compared to the oval shape of the normal mitral annulus (A). MR: metral regurgitation.

Mentions: The development of three-dimensional (3D) echocardiography, especially transesophageal 3D echocardiography, offers a great advantage over two-dimensional (2D) echocardiography with the possibility to visualize 'en face' the entire MV, similar to the intraoperative surgical view,16) permitting a more accurate assessment of the extent and location of the disease (Fig. 2) (Supplementary Videos 4 and 5 in the online-only Data Supplement).17) Moreover, the newly developed software based on 3D echocardiography transforms the MV in a mathematical model (Fig. 3), providing specific measurements essential for the surgeon (annulus dimensions, non-planar angle, leaflets area, or tenting height and volume). The quantification of MR severity by 3D echocardiography (3D vena contracta or regurgitant volume calculation) is feasible and superior to 2D methods, compared to gold standard MRI.18)


Management of organic mitral regurgitation: guideline recommendations and controversies.

Gurzun MM, Popescu AC, Ginghina C, Popescu BA - Korean Circ J (2015)

Mitral valve reconstruction in a normal subject (A) and in a patient with severe mitral regurgitation due to P2 scallop flail and prolapse and P3 scallop prolapse (B). The parts of the mitral valve which are below the mitral annulus plane (i.e., on the ventricular side) are color-coded in blue, while the parts which are above annulus are coded in red. Of note, the shape of the mitral annulus changes in MR, becoming circular (B), compared to the oval shape of the normal mitral annulus (A). MR: metral regurgitation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372987&req=5

Figure 3: Mitral valve reconstruction in a normal subject (A) and in a patient with severe mitral regurgitation due to P2 scallop flail and prolapse and P3 scallop prolapse (B). The parts of the mitral valve which are below the mitral annulus plane (i.e., on the ventricular side) are color-coded in blue, while the parts which are above annulus are coded in red. Of note, the shape of the mitral annulus changes in MR, becoming circular (B), compared to the oval shape of the normal mitral annulus (A). MR: metral regurgitation.
Mentions: The development of three-dimensional (3D) echocardiography, especially transesophageal 3D echocardiography, offers a great advantage over two-dimensional (2D) echocardiography with the possibility to visualize 'en face' the entire MV, similar to the intraoperative surgical view,16) permitting a more accurate assessment of the extent and location of the disease (Fig. 2) (Supplementary Videos 4 and 5 in the online-only Data Supplement).17) Moreover, the newly developed software based on 3D echocardiography transforms the MV in a mathematical model (Fig. 3), providing specific measurements essential for the surgeon (annulus dimensions, non-planar angle, leaflets area, or tenting height and volume). The quantification of MR severity by 3D echocardiography (3D vena contracta or regurgitant volume calculation) is feasible and superior to 2D methods, compared to gold standard MRI.18)

Bottom Line: The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair.Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed.Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.

ABSTRACT
Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.

No MeSH data available.


Related in: MedlinePlus