Functional Mitral Regurgitation: If the Myocardium Is Guilty Do We Also Need to ‘Rehabilitate’ the Valve?

*Martino Pepe,1 Valeria Paradies,1 Fabrizio Resta,1 Alessandro Cafaro,1 Francesco Bartolomucci,2 Filippo Masi,1 Donato Quagliara,1 Stefano Favale1

1. Unità Operativa Cardiologia Universitaria, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
2. Unità Operativa Cardiologia, Ospedale Bonomo, Andria, Italy
*Correspondence to drmartinopepe@libero.it

Disclosure: No potential conflict of interest.
Received: 05.11.14 Accepted: 15.12.14
Citation: EMJ Cardiol. 2015;3[1]:38-47.

Abstract

Mitral regurgitation (MR) is the most frequent valvulopathy in the general population with an incidence that grows with age and is associated with a poor prognosis. Regardless of its primary cause, which can be both ischaemic and non-ischaemic cardiomyopathy, it finally activates a self-feeding process. Due to the complexity of mitral valve (MV) apparatus and its interaction with the myocardium, even the diagnosis could represent a challenge for physicians. Higher technological instruments such as 3D  echocardiography and cardiac magnetic resonance could play an important role in the evaluation of  MV. In this paper we reviewed the most salient aspects of functional MR pathophysiology as well as the  current diagnostic methods. The management of functional mitral regurgitation (FMR) is even more challenging and controversial; the optimal approach, timing, and effectiveness of interventions are still debated. Treatment of FMR begins with optimal medical therapy for left ventricular dysfunction, including cardiac resynchronisation when indicated. While functional improvement after surgery is well established, the benefits in terms of survival are still questionable. Moreover, in patients with high perioperative risk there is a growing interest in emerging percutaneous techniques. Among a variety of medical, surgical, and percutaneous opportunities, authors support an accurate case-by-case evaluation to find a tailored  and stepwise treatment according to anatomical features and patient comorbidities.

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