Mitral regurgitation: An overview

Operative Outcomes with Myxomatous Mitral Valve Repair: Experience with 586 Patients

INTRODUCTION

American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation.

METHODS

We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012. All patients had pre- and postoperative transthoracic echocardiograms.

RESULTS

In the first 30 days postoperatively there were five deaths (0.9%), four strokes (0.7%) and five transient ischaemic attacks (TIAs) (0.9%). Repair involved resection in 55.5%, neochordal reconstruction in 41.6%, and in 2.9% a combination of both. There was increasing use of neochordae since 2006. At discharge 99% had mitral regurgitation (MR) ≤ mild and ≤ trivial in 79.5%. For posterior leaflet disease neochordae had improved MR at discharge compared with resection (85% vs 78%, P<0.05). Preoperative triscupid regurgitation (TR) and pulmonary hypertension > mild were associated with a greater degree of MR at discharge (P<0.05) for reasons that are unclear.

CONCLUSION

We have shown excellent early results for mitral repair with very low operative mortality and excellent freedom from significant MR. Successful mitral repairs with low morbidity have resulted in a pattern of early referral in keeping with the current guidelines.

Transthoracic and Transesophageal Echocardiographic Assessment of Mitral Regurgitation Severity: Usefulness of Qualitative and Semiquantitative Techniques

In this report, we review the advantages, limitations, and optimal utilization of various transthoracic and transesophageal echocardiographic (TTE and TEE) methods used for assessing mitral regurgitation (MR) as published in full-length, peer-reviewed articles since the color Doppler era began in 1984. In addition, comparison is made to other imaging modalities including catheter-based, magnetic resonance and surgical assessment of MR. Although left ventricular (LV) angiography has been traditionally used for validation of various TTE methods and is time-honored, its considerable limitations preclude it from being a real "gold standard." Based on the reviewed literature, no clear "gold standard" for the assessment of MR can be identified at present, but newly emerging TTE and TEE techniques, such as three-dimensional color Doppler, may have the potential to overcome some of the limitations of the two-dimensional methods.

CT of valvular heart disease

Although the incidence of valvular heart disease is significantly less than before the introduction of antibiotic therapy, chronic mitral and aortic valve disease continues to be found in the adult population. CT examination reveals characteristic chamber volume and myocardial mass changes expected in patients with valvular obstruction and regurgitation. Furthermore, CT provides sensitive visualization of annular and valve leaflet calcification, both of which are important findings for determining the presence of disease and estimating the significance of valvular dysfunction identified on examination. Although CT is by no means the first diagnostic modality to be employed in management of patients with valvular heart disease, it does reveal the sequelae of such disease, and may, in fact, provide insight into the significance of clinical or echocardiographic findings. Improved temporal resolution will increase the accuracy of CT diagnosis, and further expand its use for diagnosing and managing patients with cardiac disease in general, and valvular heart disease, in particular.

Assessment of valvular heart disease. Why echocardiography is an essential component

Assessment of patients with valvular heart disease has undergone many changes in the past few decades with the introduction of noninvasive techniques such as echocardiography. Along with the history, physical examination, electrocardiogram, and chest films, echocardiography is an important component of the assessment, providing essential information for diagnosis and follow-up.