Mitral insufficiency and its different aetiologies: old and new insights for appropriate surgical indications and treatment.
Mitral insufficiency, as many other fields in medicine, has witnessed profound changes in terms of knowledge, diagnostic process and therapeutic options. Mitral valve reconstruction has become the treatment of choice in the presence of a regurgitant valve, although numerous preoperative and operative clues have been shown to predict less satisfactory results of valve repair in the long term, calling for a careful revision of postoperative data and search for novel techniques of valve repair or reconsider valve replacement as an acceptable therapy in peculiar cases. Old scenarios, like rheumatic valve disease or acute endocarditis, are continuously under reassessment in an attempt to distinguish patient subsets amenable to tailored therapies, whereas new fields of intervention, like dilated cardiomyopathy, or better appraisal of pathophysiological mechanisms, like ischaemic mitral insufficiency, are emerging and represent new indications for surgical solutions. The most recent advances in the understanding of how some aetiologies and related mechanisms of mitral insufficiency exert substantial influence on the postoperative results represent new tools in the guidance of a more appropriate surgical decision-making.
Lorusso
Roberto
R
Cardiac Surgery Unit, Civic Hospital, Brescia, Italy. roberto_lorusso@iol.it
De Bonis
Michele
M
De Cicco
Giuseppe
G
Maisano
Francesco
F
Fucci
Carlo
C
Alfieri
Ottavio
O
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000601:surgery; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000150:complications / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery; D010210:Papillary Muscles / Q000601:surgery*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012214:Rheumatic Heart Disease / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000601:surgery
D000900:Anti-Bacterial Agents