Chapter 30: Mitral Regurgitation

Content Update

Reshaping Our View of Mitral Regurgitation in Heart Failure

The RESHAPE-HF2 study was a randomized, controlled, open-label trial comparing transcatheter mitral-valve edge-to-edge repair (TCMVR) plus guideline-recommended medical therapy to medical therapy alone in patients with symptomatic heart failure (HF) and moderate to severe functional mitral regurgitation. Read More

Content Update

MATTERHORN Trial Review

The MATTERHORN study evaluated mitral valve transcatheter edge-to-edge repair (M-TEER) versus surgical mitral valve repair among patients with secondary mitral regurgitation (MR). Read More

Content Update

MitraClip Continues to Outperform Medical Therapy Alone at 5-years, but Event Rates Remain High

The COAPT trial investigators randomized 614 patients with heart failure with left ventricular reduced ejection fraction (20-50%) on maximally tolerated guideline-directed medical therapy and symptomatic moderate-to-severe or severe secondary mitral regurgitation to either transcatheter edge-to-edge repair (TEER) with the MitraClip (Abbott) (n = 302) or medical therapy alone (n = 312). Read More

Chapter Summary

This chapter provides a comprehensive overview of the epidemiology, pathophysiology, diagnosis, and treatment of primary and secondary mitral regurgitation (MR). MR is the most frequent valve disease in the population (estimated prevalence 20%) and, as a disease of the elderly, prevalence will increase steeply over the next few decades. Primary MR results from valvular abnormalities whereas secondary MR is a consequence of left ventricular dysfunction/dilatation or left atrial enlargement/dysfunction (see Fuster and Hurst's Central Illustration). Significant MR is associated with high morbidity/mortality when left untreated, with 5-year survival of 46 ± 3% in secondary MR and 66 ± 3% in primary MR. Still, most MR patients are treated conservatively. MR diagnosis/quantification is performed with two- and three-dimensional transthoracic echocardiography, which provides anatomical and functional information to understand the MR pathophysiology. Cardiac magnetic resonance is ideal for MR quantification. When transcatheter mitral valve repair/replacement is being considered, detailed anatomical imaging of the mitral valve (including annular calcification) can be provided by cardiac computed tomography. Surgical therapies and transcatheter mitral valve repair/replacement are discussed, and a summary of the recommendations from the latest ESC/EACTS and ACC/AHA guidelines for treatment of primary and secondary MR is provided.