Degenerative Mitral Regurgitation

Overview

Journal Nat Rev Dis Primers

Specialty General Medicine

Date 2023 Dec 7

PMID 38062018

Authors

Victoria Delgado

Nina Ajmone Marsan

Robert O Bonow

Rebecca T Hahn

Russell A Norris

Liesl Zuhlke

Michael A Borger

Affiliations

Soon will be listed here.

Abstract

Degenerative mitral regurgitation is a major threat to public health and affects at least 24 million people worldwide, with an estimated 0.88 million disability-adjusted life years and 34,000 deaths in 2019. Improving access to diagnostic testing and to timely curative therapies such as surgical mitral valve repair will improve the outcomes of many individuals. Imaging such as echocardiography and cardiac magnetic resonance allow accurate diagnosis and have provided new insights for a better definition of the most appropriate timing for intervention. Advances in surgical techniques allow minimally invasive treatment with durable results that last for ≥20 years. Transcatheter therapies can provide good results in select patients who are considered high risk for surgery and have a suitable anatomy; the durability of such repairs is up to 5 years. Translational science has provided new knowledge on the pathophysiology of degenerative mitral regurgitation and may pave the road to the development of medical therapies that could be used to halt the progression of the disease.

Citing Articles

Contemporary Outcomes of Degenerative Mitral Valve Surgery in a Regional Tertiary Care Center.

Berretta P, Galeazzi M, Spagnolo F, Giusti M, DAlessio S, Bifulco O J Clin Med. 2024; 13(22).

PMID: 39597894 PMC: 11595119. DOI: 10.3390/jcm13226751.

Wearable device-measured moderate to vigorous physical activity and risk of degenerative aortic valve stenosis.

Li Z, Cheng S, Guo B, Ding L, Liang Y, Shen Y Eur Heart J. 2024; 46(7):649-664.

PMID: 38953786 PMC: 11825145. DOI: 10.1093/eurheartj/ehae406.

References

Liu B, Edwards N, Pennell D, Steeds R . The evolving role of cardiac magnetic resonance in primary mitral regurgitation: ready for prime time?. Eur Heart J Cardiovasc Imaging. 2018; 20(2):123-130. PMC: 6343082. DOI: 10.1093/ehjci/jey147. View

van Wijngaarden A, Hiemstra Y, Koopmann T, Ruivenkamp C, Aten E, Schalij M . Identification of known and unknown genes associated with mitral valve prolapse using an exome slice methodology. J Med Genet. 2020; 57(12):843-850. DOI: 10.1136/jmedgenet-2019-106715. View

Perazzolo Marra M, Basso C, De Lazzari M, Rizzo S, Cipriani A, Giorgi B . Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse. Circ Cardiovasc Imaging. 2016; 9(8):e005030. PMC: 4991345. DOI: 10.1161/CIRCIMAGING.116.005030. View

Ajmone Marsan N, Delgado V, Shah D, Pellikka P, Bax J, Treibel T . Valvular heart disease: shifting the focus to the myocardium. Eur Heart J. 2022; 44(1):28-40. PMC: 9805407. DOI: 10.1093/eurheartj/ehac504. View

Tromp J, Seekings P, Hung C, Iversen M, Frost M, Ouwerkerk W . Automated interpretation of systolic and diastolic function on the echocardiogram: a multicohort study. Lancet Digit Health. 2021; 4(1):e46-e54. DOI: 10.1016/S2589-7500(21)00235-1. View

Suri R, Vanoverschelde J, Grigioni F, Schaff H, Tribouilloy C, Avierinos J . Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA. 2013; 310(6):609-16. DOI: 10.1001/jama.2013.8643. View

Lindsay M, Schepers D, Bolar N, Doyle J, Gallo E, Fert-Bober J . Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm. Nat Genet. 2012; 44(8):922-7. PMC: 3616632. DOI: 10.1038/ng.2349. View

Javadikasgari H, Mihaljevic T, Suri R, Svensson L, Navia J, Wang R . Simple versus complex degenerative mitral valve disease. J Thorac Cardiovasc Surg. 2018; 156(1):122-129.e16. DOI: 10.1016/j.jtcvs.2018.02.102. View

Miller M, Dukkipati S, Turagam M, Liao S, Adams D, Reddy V . Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week. J Am Coll Cardiol. 2018; 72(23 Pt A):2904-2914. DOI: 10.1016/j.jacc.2018.09.048. View

10.

Debonnaire P, Palmen M, Ajmone Marsan N, Delgado V . Contemporary imaging of normal mitral valve anatomy and function. Curr Opin Cardiol. 2012; 27(5):455-64. DOI: 10.1097/HCO.0b013e328354d7b5. View

11.

David T, David C, Tsang W, Lafreniere-Roula M, Manlhiot C . Long-Term Results of Mitral Valve Repair for Regurgitation Due to Leaflet Prolapse. J Am Coll Cardiol. 2019; 74(8):1044-1053. DOI: 10.1016/j.jacc.2019.06.052. View

12.

Morse D, Hamlett W, Noble Jr C . Morphogenesis of chordae tendineae. I: Scanning electron microscopy. Anat Rec. 1984; 210(4):629-38. DOI: 10.1002/ar.1092100410. View

13.

Kitkungvan D, Yang E, El Tallawi K, Nagueh S, Nabi F, Khan M . Prognostic Implications of Diffuse Interstitial Fibrosis in Asymptomatic Primary Mitral Regurgitation. Circulation. 2019; 140(25):2122-2124. PMC: 7556709. DOI: 10.1161/CIRCULATIONAHA.119.043250. View

14.

Levine R, Hagege A, Judge D, Padala M, Dal-Bianco J, Aikawa E . Mitral valve disease--morphology and mechanisms. Nat Rev Cardiol. 2015; 12(12):689-710. PMC: 4804623. DOI: 10.1038/nrcardio.2015.161. View

15.

Kyndt F, Gueffet J, Probst V, Jaafar P, Legendre A, LE Bouffant F . Mutations in the gene encoding filamin A as a cause for familial cardiac valvular dystrophy. Circulation. 2006; 115(1):40-9. DOI: 10.1161/CIRCULATIONAHA.106.622621. View

16.

Roberts W, Vowels T, Ko J, Hebeler Jr R . Gross and histological features of excised portions of posterior mitral leaflet in patients having operative repair of mitral valve prolapse and comments on the concept of missing (= ruptured) chordae tendineae. J Am Coll Cardiol. 2013; 63(16):1667-74. DOI: 10.1016/j.jacc.2013.11.017. View

17.

Rusinaru D, Tribouilloy C, Grigioni F, Avierinos J, Suri R, Barbieri A . Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study. Circ Cardiovasc Imaging. 2011; 4(5):473-81. DOI: 10.1161/CIRCIMAGING.110.961011. View

18.

Benfari G, Sorajja P, Pedrazzini G, Taramasso M, Gavazzoni M, Biasco L . Association of transcatheter edge-to-edge repair with improved survival in older patients with severe, symptomatic degenerative mitral regurgitation. Eur Heart J. 2022; 43(17):1626-1635. DOI: 10.1093/eurheartj/ehab910. View

19.

Namazi F, Vo N, Delgado V . Imaging of the mitral valve: role of echocardiography, cardiac magnetic resonance, and cardiac computed tomography. Curr Opin Cardiol. 2020; 35(5):435-444. DOI: 10.1097/HCO.0000000000000779. View

20.

Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M . Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021; 18(12):853-864. DOI: 10.1038/s41569-021-00570-z. View