Surgical timing of degenerative mitral regurgitation: what to consider.
Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
Department of Medicine, Yong Loo Lin School of Medicine, Singapore.
Maria Consolacion
MC
Dolor-Torres
Lieng H
LH
Ling
Degenerative; Mitral regurgitation; Risk stratification; Surgical timing