Medical and surgical treatment of chronic mitral regurgitation.
Chronic severe mitral regurgitation is a progressive disease that can lead to left ventricular dysfunction. New information on the natural history of the disease, along with advances in surgical techniques, has changed the roles of medical and surgical therapies. There is no well-defined role for medical therapy in chronic mitral regurgitation. The goal of the treating physician is therefore to identify the optimal timing for surgical intervention. The timing of surgical intervention depends primarily on two factors: (i) clinical symptoms and (ii) the left ventricular response to volume overload. However, the aetiology of mitral regurgitation, the likelihood of surgical repair, the occurrence of atrial fibrillation and the presence of pulmonary hypertension, together with the haemodynamic response to exercise, are important factors in the optimal surgical timing. New concepts in the understanding of the natural history of the disease coupled with success of mitral repair have recently resulted in a widespread evolution towards earlier surgery.
Chirillo
Fabio
F
Cardiology Unit, Cardiovascular Department, Ca' Foncello Hospital, Treviso, Italy. fchirillo@ulss.tv.it
Salvador
Loris
L
Cavallini
Claudio
C
D002311:Cardiomyopathy, Dilated / Q000601:surgery; D002908:Chronic Disease; D015897:Comorbidity; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000187:drug effects; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000187:drug effects
D014665:Vasodilator Agents