Skip to main content

Mitral Regurgitation

  • Chapter
  • First Online:
Heart Valve Disease

Abstract

Mitral regurgitation is the heart valve disease with the highest prevalence and the second most frequently needing intervention. Primary mitral regurgitation is caused by abnormalities of the mitral valve components, whilst secondary mitral regurgitation is caused by abnormalities of the juxtaposed cardiac chambers, the left ventricle and/or the left atrium. Assessment, prognosis and management of mitral regurgitation depend on the primary or secondary nature of the disease. This chapter describes mitral regurgitation pathogenesis, epidemiology, aetiology, physiopathology, clinical presentation, physical examination, diagnosis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dal-Bianco JP, Beaudoin J, Levine RA. Basic mechanisms of mitral regurgitation. Can J Cardiol. 2014;30(9):971–81. https://doi.org/10.1016/j.cjca.2014.06.022.

    Article  PubMed  Google Scholar 

  2. Carpentier A, Adams DH, Filsoufi F. Carpentier’s reconstructive valve surgery. from valve analysis to valve reconstruction. Philadelphia: Saunders Elsevier; 2010.

    Google Scholar 

  3. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11.

    Article  PubMed  Google Scholar 

  4. Andell P, Li X, Martinsson A, et al. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart. 2017;103:1696–703.

    Article  PubMed  Google Scholar 

  5. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231–43.

    Article  PubMed  Google Scholar 

  6. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373(9672):1382–94. https://doi.org/10.1016/S0140-6736(09)60692-9. Epub 2009 Apr 6.

    Article  PubMed  Google Scholar 

  7. Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999;341(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  8. Delling FN, Vasan RS. Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics, and molecular basis. Circulation. 2014;129(21):2158–70. https://doi.org/10.1161/CIRCULATIONAHA.113.006702.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Waller BF, Morrow AG, Maron BJ, Del Negro AA, Kent KM, McGrath FJ, Wallace RB, McIntosh CL, Roberts WC. Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am Heart J. 1982;104(pt 1):276–88.

    Article  CAS  PubMed  Google Scholar 

  10. Olson L, Subramanian R, Ackermann D, Orszulak T, Edwards W. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc. 1987;62:22–34.

    Article  CAS  PubMed  Google Scholar 

  11. M E-S, Freeman WK, Tribouilloy CM, Orszulak TA, Khandheria BK, Seward JB, Bailey KR, Tajik AJ. Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography. J Am Coll Cardiol. 1999;34(4):1129–36.

    Article  Google Scholar 

  12. El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging. 2018;11(4):628–43. https://doi.org/10.1016/j.jcmg.2018.01.009.

    Article  PubMed  Google Scholar 

  13. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births incidence and natural history. Circulation. 1971;43:323–32.

    Article  CAS  PubMed  Google Scholar 

  14. Boudoulas KD, Borer JS, Boudoulas H. Etiology of valvular heart disease in the 21st century. Cardiology. 2013;126(3):139–52. https://doi.org/10.1159/000354221. Epub 2013 Aug 24.

    Article  PubMed  Google Scholar 

  15. Delling FN, Rong J, Larson MG, Lehman B, Fuller D, Osypiuk E, Stantchev P, Hackman B, Manning WJ, Benjamin EJ, Levine RA, Vasan RS. Evolution of mitral valve prolapse: insights from the Framingham Heart Study. Circulation. 2016;133(17):1688–95. https://doi.org/10.1161/CIRCULATIONAHA.115.020621. Epub 2016 Mar 22.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Enriquez-Sarano M, Basmadjian AJ, Rossi A, Bailey KR, Seward JB, Tajik AJ. Progression of mitral regurgitation: a prospective Doppler echocardiographic study. J Am Coll Cardiol. 1999;34(4):1137–44.

    Article  CAS  PubMed  Google Scholar 

  17. Rossi A, Dini FL, Faggiano P, Agricola E, Cicoira M, Frattini S, Simioniuc A, Gullace M, Ghio S, Enriquez-Sarano M, Temporelli PL. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart. 2011;97(20):1675–80.

    Article  PubMed  Google Scholar 

  18. Goliasch G, Bartko PE, Pavo N, Neuhold S, Wurm R, Mascherbauer J, Lang IM, Strunk G, Hülsmann M. Refining the prognostic impact of functional mitral regurgitation in chronic heart failure. Eur Heart J. 2018;39(1):39–46.

    Article  CAS  PubMed  Google Scholar 

  19. Bursi F, Barbieri A, Grigioni F, Reggianini L, Zanasi V, Leuzzi C, Ricci C, Piovaccari G, Branzi A, Modena MG. Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: a long-term outcome study. Eur J Heart Fail. 2010;12:382–8.

    Article  PubMed  Google Scholar 

  20. Trivi M, Thierer J, Kuschnir P, Acosta A, Marino J, Guglielmone R, Ronderos R. Echocardiographic predictors of exercise capacity in patients with heart failure and systolic dysfunction: role of mitral regurgitation. Rev Esp Cardiol. 2011;64(12):1096–9.

    Article  PubMed  Google Scholar 

  21. Ennezat PV, Sylvestre Maréchaux S, Pibarot P, Le Jemtel TH. Secondary mitral regurgitation in heart failure with reduced or preserved left ventricular ejection fraction. Cardiology. 2013;125:110–7.

    Article  PubMed  Google Scholar 

  22. Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure. Pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol. 2015;65:1231–48.

    Article  PubMed  Google Scholar 

  23. Gertz ZM, Raina A, Saghy L, Zado ES, Callans DJ, Marchlinski FE, Keane MG, Silvestry FE. Evidence of atrial functional mitral regurgitation due to atrial fibrillation. Reversal with arrhythmia control. J Am Coll Cardiol. 2011;58:1474–81.

    Article  PubMed  Google Scholar 

  24. Le Tourneau T, Mérot J, Rimbert A, Le Scouarnec S, Probst V, Le Marec H, Levine RA, Schott JJ. Genetics of syndromic and non-syndromic mitral valve prolapse. Heart. 2018;104(12):978–84. https://doi.org/10.1136/heartjnl-2017-312420. Epub 2018 Jan 19.

    Article  CAS  PubMed  Google Scholar 

  25. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J. 2010;31(16):1958–66. https://doi.org/10.1093/eurheartj/ehq222. Epub 2010 Jul 11.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Anyanwu AC, Adams DH. Etiologic classification of degenerative mitral valve disease: Barlow’s disease and fibroelastic deficiency. Semin Thorac Cardiovasc Surg. 2007;19(2):90–6.

    Article  PubMed  Google Scholar 

  27. Hjortnaes J, Keegan J, Bruneval P, Schwartz E, Schoen FJ, Carpentier A, Levine RA, Hagège A, Aikawa E. Comparative histopathological analysis of mitral valves in barlow disease and fibroelastic deficiency. Semin Thorac Cardiovasc Surg. 2016;28(4):757–67. https://doi.org/10.1053/j.semtcvs.2016.08.015. Epub 2016 Sep 5.

    Article  PubMed  Google Scholar 

  28. Gaasch WH, Meyer TE. Left ventricular response to mitral regurgitation: implications for management. Circulation. 2008;118(22):2298–303. https://doi.org/10.1161/CIRCULATIONAHA.107.755942.

    Article  PubMed  Google Scholar 

  29. Ahmed MI, Guichard JL, Soorappan RN, Ahmad S, Mariappan N, Litovsky S, Gupta H, Lloyd SG, Denney TS, Powell PC, Aban I, Collawn J, Davies JE, McGiffin DC, Dell’Italia LJ. Disruption of desmin-mitochondrial architecture in patients with regurgitant mitral valves and preserved ventricular function. J Thorac Cardiovasc Surg. 2016;152(4):1059–1070.e2. https://doi.org/10.1016/j.jtcvs.2016.06.017. Epub 2016 Jun 25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Ehlers KH, Engle MA, Levin AR, Grossman H, Fleming R. Left ventricular abnormality with late mitral insufficiency and abnormal electrocardiogram. Am J Cardiol. 1970;26:333–40.

    Article  CAS  PubMed  Google Scholar 

  31. Liedtke AJ, Gault JH, Leaman DM, Blumenthal MS. Geometry of left ventricular contraction in the systolic click syndrome. Characterization of a segmental myocardial abnormality. Circulation. 1973;47:27–35.

    Article  CAS  PubMed  Google Scholar 

  32. Gooch AS, Vicencio F, Maranhao V, Goldberg H. Arrhythmias and left ventricular asynergy in the prolapsing mitral leaflet syndrome. Am J Cardiol. 1972;29:611–20.

    Article  CAS  PubMed  Google Scholar 

  33. Sriram CS, Syed FF, Ferguson ME, Johnson JN, Enriquez-Sarano M, Cetta F, Cannon BC, Asirvatham SJ, Ackerman MJ. Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest. J Am Coll Cardiol. 2013;62:222–30.

    Article  PubMed  Google Scholar 

  34. Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL, Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14(7):611–44. https://doi.org/10.1093/ehjci/jet105. Epub 2013 Jun 3.

    Article  PubMed  Google Scholar 

  35. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30(4):303–71. https://doi.org/10.1016/j.echo.2017.01.007. Epub 2017 Mar 14.

    Article  PubMed  Google Scholar 

  36. Silbiger JJ. Mechanistic insights into ischemic mitral regurgitation: echocardiographic and surgical implications. J Am Soc Echocardiogr. 2011;24:707–19. https://doi.org/10.1016/j.echo.2011.04.001.

    Article  PubMed  Google Scholar 

  37. Garbi M, Monaghan MJ. Quantitative mitral valve anatomy and pathology. Echo Res Pract. 2015;2(3):R63–72.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.e14. https://doi.org/10.1016/j.echo.2014.10.003.

    Article  PubMed  Google Scholar 

  39. Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popović ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. J Am Coll Cardiol. 2013;61(1):77–84. https://doi.org/10.1016/j.jacc.2012.09.035. Epub 2012 Nov 28.

    Article  PubMed  Google Scholar 

  40. Kim HM, Cho GY, Hwang IC, Choi HM, Park JB, Yoon YE, Kim HK. Myocardial strain in prediction of outcomes after surgery for severe mitral regurgitation. JACC Cardiovasc Imaging. 2018;11(9):1235–44. https://doi.org/10.1016/j.jcmg.2018.03.016. Epub 2018 May 16.

    Article  PubMed  Google Scholar 

  41. Le Tourneau T, Messika-Zeitoun D, Russo A, Detaint D, Topilsky Y, Mahoney DW, Suri R, Enriquez-Sarano M. Impact of left atrial volume on clinical outcome in organic mitral regurgitation. J Am Coll Cardiol. 2010;56(7):570–8. https://doi.org/10.1016/j.jacc.2010.02.059.

    Article  PubMed  Google Scholar 

  42. Le Tourneau T, Richardson M, Juthier F, Modine T, Fayad G, Polge AS, Ennezat PV, Bauters C, Vincentelli A, Deklunder G. Echocardiography predictors and prognostic value of pulmonary artery systolic pressure in chronic organic mitral regurgitation. Heart. 2010;96(16):1311–7. https://doi.org/10.1136/hrt.2009.186486.

    Article  PubMed  Google Scholar 

  43. Magne J, Lancellotti P, Piérard LA. Exercise-induced changes in degenerative mitral regurgitation. J Am Coll Cardiol. 2010;56:300–9.

    Article  PubMed  Google Scholar 

  44. Lancellotti P, Magne J. Stress testing for the evaluation of patients with mitral regurgitation. Curr Opin Cardiol. 2012;27:492–8.

    Article  PubMed  Google Scholar 

  45. Magne J, Lancellotti P, Pierard LA. Stress echocardiography and mitral valvular heart disease. Cardiol Clin. 2013;31:311–21.

    Article  PubMed  Google Scholar 

  46. Lancellotti P, Dulgheru R, Go YY, Sugimoto T, Marchetta S, Oury C, Garbi M. Stress echocardiography in patients with native valvular heart disease. Heart. 2017;0:1–7. https://doi.org/10.1136/heartjnl-2017-311682.

    Article  CAS  Google Scholar 

  47. Lee R, Haluska B, Leung DY, et al. Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart. 2005;91:1407–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Magne J, Mahjoub H, Dulgheru R, et al. Left ventricular contractile reserve in asymptomatic primary mitral regurgitation. Eur Heart J. 2014;35:1608–16.

    Article  CAS  PubMed  Google Scholar 

  49. Magne J, Lancellotti P, Piérard LA. Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation. Circulation. 2010;122:33–41.

    Article  PubMed  Google Scholar 

  50. Lancellotti P, Martinez C, Bernard A. Pulmonary pressures and outcome in primary mitral regurgitation: paradigm shift from rung to ladder. J Am Coll Cardiol. 2016;67:2962–4.

    Article  PubMed  Google Scholar 

  51. Magne J, Donal E, Mahjoub H, et al. Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation. Heart. 2015;101:391–6.

    Article  PubMed  Google Scholar 

  52. Piérard LA, Lancellotti P. The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema. N Engl J Med. 2004;351:1627–34.

    Article  PubMed  Google Scholar 

  53. Christiansen JP, Karamitsos TD, Myerson SG. Assessment of valvular heart disease by cardiovascular magnetic resonance imaging: a review. Heart Lung Circ. 2011;20:73–82.

    Article  PubMed  Google Scholar 

  54. Han Y, Peters DC, Salton CJ, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging. 2008;1:294–303.

    Article  PubMed  Google Scholar 

  55. Lancellotti P, Zamorano JL, Vannan MA. Imaging challenges in secondary mitral regurgitation: unsolved issues and perspectives. Circ Cardiovasc Imaging. 2014;7:735–46.

    Article  PubMed  Google Scholar 

  56. Pontone G, Andreini D, Bertella E, Cortinovis S, Mushtaq S, Foti C, Annoni A, Formenti A, Baggiano A, Conte E, Ballerini G, Fiorentini C, Bartorelli AL, Pepi M. Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: comparison of accuracy, radiation dose and cost versus invasive coronary angiography. Int J Cardiol. 2013;167:2889–94.

    Article  PubMed  Google Scholar 

  57. Guo YK, Yang ZG, Ning G, et al. Isolated mitral regurgitation: quantitative assessment with 64-section multidetector CT—comparison with MR imaging and echocardiography. Radiology. 2009;252:369–76.

    Article  PubMed  Google Scholar 

  58. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.

    Article  PubMed  Google Scholar 

  59. Casselman FP, Van Slycke S, Wellens F, et al. From classical sternotomy to truly endoscopic mitral valve surgery: a step by step procedure. Heart Lung Circ. 2003;12:172–7.

    Article  PubMed  Google Scholar 

  60. Modi P, Rodriguez E, Hargrove WC III, et al. Minimally invasive videoassisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg. 2009;137:1481–7.

    Article  PubMed  Google Scholar 

  61. Chan KM, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation. 2012;126:2502–10.

    Article  PubMed  Google Scholar 

  62. Carpentier A. Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.

    CAS  PubMed  Google Scholar 

  63. Dreyfus GD, Dulguerov F, Marcacci C, Haley SR, Gkouma A, Dommerc C, Albert A. “Respect when you can, resect when you should”: a realistic approach to posterior leaflet mitral valve repair. J Thorac Cardiovasc Surg. 2018;156(5):1856–66.

    Article  PubMed  Google Scholar 

  64. Adams DH, Anyanwu AC, Sugeng L, et al. Degenerative mitral valve regurgitation: surgical echocardiography. Curr Cardiol Rep. 2008;10:226–32.

    Article  PubMed  Google Scholar 

  65. Seeburger J, Kuntze T, Mohr FW. Gore-tex chordoplasty in degenerative mitral valve repair. Semin Thorac Cardiovasc Surg. 2007;19:111–5.

    Article  PubMed  Google Scholar 

  66. Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation. 2001;104:I8–11.

    Article  CAS  PubMed  Google Scholar 

  67. Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg. 2010;37:1039–46.

    Article  PubMed  Google Scholar 

  68. Maisano F, et al. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg. 1998;13(3):240–5. discussion 245–6.

    Article  CAS  PubMed  Google Scholar 

  69. Condado JA, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv. 2006;67(2):323–5.

    Article  PubMed  Google Scholar 

  70. Attizzani GF, et al. Extended use of percutaneous edge-to-edge mitral valve repair beyond EVEREST (Endovascular Valve Edge-to-Edge Repair) criteria: 30-day and 12-month clinical and echocardiographic outcomes from the GRASP (Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation) registry. JACC Cardiovasc Interv. 2015;8(1 Pt A):74–82.

    Article  PubMed  Google Scholar 

  71. Taramasso M, Maisano F. Challenging mitral clefts with MitraClip: the convergent clips strategy. EuroIntervention. 2016;12(8):e1071.

    Article  PubMed  Google Scholar 

  72. Singh GD, Smith TW, Rogers TH. Multi-MitraClip therapy for severe degenerative mitral regurgitation: “anchor” technique for extremely flail segments. Catheter Cardiovasc Interv. 2015;86(2):339–46.

    Article  PubMed  Google Scholar 

  73. Kische S, Nienaber C, Ince H. Use of four MitraClip devices in a patient with ischemic cardiomyopathy and mitral regurgitation: “zipping by clipping”. Catheter Cardiovasc Interv. 2012;80(6):1007–13.

    Article  PubMed  Google Scholar 

  74. Weinmann K, et al. First experience with MitraClip XTR device for severe mitral valve prolapse (Barlow’s disease). EuroIntervention. 2018;14(12):e1276–7.

    Article  PubMed  Google Scholar 

  75. Colli A, et al. Prognostic impact of leaflet-to-annulus index in patients treated with transapical off-pump echo-guided mitral valve repair with NeoChord implantation. Int J Cardiol. 2018;257:235–7.

    Article  PubMed  Google Scholar 

  76. Colli A, et al. An early European experience with transapical off-pump mitral valve repair with NeoChord implantation. Eur J Cardiothorac Surg. 2018;54(3):460–6.

    Article  PubMed  Google Scholar 

  77. Kuwata S, et al. Transcatheter mitral annuloplasty in Barlow’s mitral regurgitation with deep cleft. JACC Cardiovasc Interv. 2018;11(12):e97–8.

    Article  PubMed  Google Scholar 

  78. Brustle K, et al. Transcatheter mitral annuloplasty to treat residual mitral regurgitation after MitraClip implantation. EuroIntervention. 2017;13(8):912–3.

    Article  PubMed  Google Scholar 

  79. Muller DWM, et al. Transcatheter mitral valve replacement for patients with symptomatic mitral regurgitation: a global feasibility trial. J Am Coll Cardiol. 2017;69(4):381–91.

    Article  PubMed  Google Scholar 

  80. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola V-P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der MP, Authors/Task Force Members. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129–200.

    Article  PubMed  Google Scholar 

  81. Bartko PE, Dal-Bianco JP, Guerrero JL, Beaudoin J, Szymanski C, Kim D-H, Seybolt MM, Handschumacher MD, Sullivan S, Garcia ML, Titus JS, Wylie-Sears J, Irvin WS, Messas E, Hagège AA, Carpentier A, Aikawa E, Bischoff J, Levine RA, Network LTM. Effect of losartan on mitral valve changes after myocardial infarction. J Am Coll Cardiol. 2017;70:1232–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Kang D-H, Park S-J, Shin S-H, Hong G-R, Lee S, Kim M-S, Yun S-C, Song J-M, Park S-W, Kim J-J. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation. Circulation. 2019;139:1354–65.

    Article  CAS  PubMed  Google Scholar 

  83. Aklog L, Filsoufi F, Flores F, Chen RH, Cohn LH, Nathan NS, Byrne JG, Adams DH. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation. 2001;104:68–75.

    Article  Google Scholar 

  84. Goldstein D, Moskowitz AJ, Gelijns AC, Ailawadi G, Parides MK, Perrault LP, Hung JW, Voisine P, Dagenais F, Gillinov AM, Thourani V, Argenziano M, Gammie JS, Mack M, Demers P, Atluri P, Rose EA, O’Sullivan K, Williams DL, Bagiella E, Michler RE, Weisel RD, Miller MA, Geller NL, Taddei-Peters WC, Smith PK, Moquete E, Overbey JR, Kron IL, O’Gara PT, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med. 2016;374:344–53.

    Article  CAS  PubMed  Google Scholar 

  85. Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, Acker MA, Hung JW, Chang HL, Perrault LP, Gillinov AM, Argenziano M, Bagiella E, Overbey JR, Moquete EG, Gupta LN, Miller MA, Taddei-Peters WC, Jeffries N, Weisel RD, Rose EA, Gammie JS, DeRose JJ, Puskas JD, Dagenais F, Burks SG, El-Hamamsy I, Milano CA, Atluri P, Voisine P, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 2016;374:1932–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Acker MA, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23–32.

    Article  CAS  PubMed  Google Scholar 

  87. Timek TA, Lai DT, Tibayan F, Liang D, Rodriguez F, Daughters GT, Dagum P, Ingels NB Jr, Miller C. Annular versus subvalvular approaches to acute ischemic mitral regurgitation. Circulation. 2002;106(12 Suppl 1):I27–32.

    PubMed  Google Scholar 

  88. De Bonis M, Lapenna E, Taramasso M, La Canna G, Buzzatti N, Pappalardo F, Alfieri O. Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: up to 21 years of clinical and echocardiographic results. J Thorac Cardiovasc Surg. 2014;148(5):2027–32.

    Article  PubMed  Google Scholar 

  89. Maisano F, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol. 2013;62(12):1052–61.

    Article  PubMed  Google Scholar 

  90. Obadia JF, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018;379:2297–306.

    Article  PubMed  Google Scholar 

  91. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ, Investigators COAPT. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379:2307–18.

    Article  PubMed  Google Scholar 

  92. Maisano F, et al. Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial. Eur Heart J. 2016;37(10):817–25.

    Article  PubMed  Google Scholar 

  93. Goldberg SL, Hammerstingl C. Coronary sinus-based approach to mitral regurgitation. Interv Cardiol Clin. 2016;5(1):93–100.

    PubMed  Google Scholar 

  94. Rogers JH, et al. Combined MitraClip edge-to-edge repair with millipede IRIS mitral annuloplasty. JACC Cardiovasc Interv. 2018;11(3):323–4.

    Article  PubMed  Google Scholar 

  95. Yoon SH, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J. 2019;40(5):441–51.

    Article  PubMed  Google Scholar 

  96. Maisano F, et al. The future of transcatheter mitral valve interventions: competitive or complementary role of repair vs. replacement? Eur Heart J. 2015;36(26):1651–9.

    Article  PubMed  Google Scholar 

  97. Cheung A, et al. Short-term results of transapical transcatheter mitral valve implantation for mitral regurgitation. J Am Coll Cardiol. 2014;64(17):1814–9.

    Article  PubMed  Google Scholar 

  98. Lancellotti P, Pibarot P, Chambers J, et al. Recommendations for the imaging assessment of prosthetic heart valves. Eur Heart J Cardiovasc Imaging. 2016;17(6):589–90.

    Article  PubMed  Google Scholar 

  99. Stone GW, Adams DH, Abraham WT et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: A consensus document from the Mitral Valve Academic Research Consortium. Eur Heart J. 2015;36(29):1878–91. doi: https://doi.org/10.1093/eurheartj/ehv333.

    Article  CAS  PubMed  Google Scholar 

  100. Ennezat PV, Sylvestre Maréchaux S, Pibarot P, Le Jemtel TH. Secondary Mitral Regurgitation in Heart Failure with Reduced or Preserved Left Ventricular Ejection Fraction. Cardiology 2013;125:110–117.

    Article  PubMed  Google Scholar 

  101. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J. 2010;31(16):1958–66. doi: https://doi.org/10.1093/eurheartj/ehq222.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Gaasch WH, Meyer TE. Left ventricular response to mitral regurgitation: implications for management. Circulation. 2008;118(22):2298–303. doi: https://doi.org/10.1161/CIRCULATIONAHA.107.755942.

    Article  PubMed  Google Scholar 

  103. Cohn LH, Tchantchaleishvili V, Rajab TK. Evolution of the concept and practice of mitral valve repair. http://dx.doi.org/10.3978/j.issn.2225-319X.2015.04.09

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patrizio Lancellotti .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Garbi, M., Magne, J., Maisano, F., Swaans, M., Dulgheru, R., Lancellotti, P. (2020). Mitral Regurgitation. In: Zamorano, J., Lancellotti, P., Pierard, L., Pibarot, P. (eds) Heart Valve Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-23104-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-23104-0_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23103-3

  • Online ISBN: 978-3-030-23104-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics