Degenerative mitral valve disease is recognized as an important cause for cardiovascular morbidity and mortality. Degeneration of the mitral valve (MV) is a common disorder affecting around 2% of the population. The most common finding in patients is leaflet prolapse, resulting in varying degrees of mitral valve regurgitation. Mitral valve prolapse due to degenerative disease is defined by a spectrum of lesions, varying from simple chordal rupture involving prolapse of an isolated segment in otherwise normally shaped valve, to multi-segmental prolapse of one or both leaflets in a valve with significant excess tissue and large annular size. The prognosis of mitral valve prolapse is usually benign and is not different from that of the general population, but these with risk factors, such as age, left ventricular dysfunction, significant mitral regurgitation (MR), enlarged left atrium/ventricle, and atrial fibrillation, are at increased risk of adverse cardiovascular events. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, because valve repair is associated with improved event-free survival as compared to valve replacement. Preoperative differentiation by both cardiologists and surgeons is important because the techniques, surgical skills and expertise required to achieve a successful repair vary among the different etiological subsets. The appropriate timing and type of intervention for patients with degenerative mitral valve regurgitation can improve the outcomes and quality of life.
Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Mitral Annulus Calcification. J Am Coll Cardiol. 2015;66(17):1934-41. doi: 10.1016/j.jacc.2015.08.872.
Adams DH, Anyanwu AC, Sugeng L, Lang RM. Degenerative mitral valve regurgitation: surgical echocardiography. Curr Cardiol Rep. 2008;10(3):226-32.
Anders S, Said S, Schulz F. Puschel K. Mitral valve prolapse syndrome as cause of sudden death in young adults. Forensic Sci Int. 2007; 171(2-3):127-30. doi: 10.1016/j.forsciint.2006.10.011.
Anyanwu AC, Adams DH. Etiologic classification of degenerative mitral valve disease: BarlowA²s disease and fibroelastic deficiency. Semin Thorac Cardiovasc Surg. 2007;19(2):90-6. doi: 10.1053/j.semtcvs.2007.04.002.
Barlow JB, Pocock WA. Billowing, floppy, prolapsed or flail mitral valves?Am J Cardiol.1985; 55:501-2.
Carpentier A, Lacour-Gayet F, Camilleri J. Fibroelastic dysplasia of the mitral valve: an anatomical and clinical entity. Circulation. 1982; 3:307.
Carpentier AF, Pellerin M, Fuzellier JF, Relland JY. Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg. 1996: 111(4): 718-29. discussion 729-730.
David TE, Ivanov J, Armstrong S, Rakowski H. Late outcomes of mitral valve repair for floppy valves: Implications for asymptomatic patients. J Thorac Cardiovasc Surg. 2003; 125(5):1143-52. doi: 10.1067/mtc.2003.406.
Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009; 373(9672):1382-94. doi: 10.1016/S0140-6736(09)60692-9.
Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, NkomoV, et al. Quantitative determinants of the outcome of asymptomatic mitral regutgitation. N Engl J Med. 2005; 352(9): 875-83. doi: 10.1056/NEJMoa041451.
Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995; 91(4): 1022-8.
Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, et al. Prevalence and clinical outcome of mitral - valve prolapse. N Eng J Med.1999; 341(1):1-7. doi: 10.1056/NEJM199907013410101.
Fornes P, Heudes D, Fuzellier JF, Tixier D, Bruneval P, Carpentier A. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segments. Cardiovasc Pathol. 1999;8(2):81-92.
Yacoub MH, Cohn LH. Novel approaches to cardiac valve repair: from structure to function. Part II. Circulation. 2004;109(9):1064-72. doi: 10.1161/01.CIR.0000115634.66549.4D.
Kang DH, Kim JH, Rim JH, Kim MJ, Yun SC, Song H, et al. Comparison of early surgery versus conventional treatment in asymptomatic severe mitral regurgitation. Circulation. 2009; 119(6): 797-804. doi: 10.1161/CIRCULATIONAHA.108.802314.
Mohty D, Enriquez-Sarano M. The long-term outcome of mitral valve repair for mitral valve prolapse. Curr Cardiol Rep. 2002;4(2):104-10.
Monin JL, Dehant P, Roiron C, Monchi M, Tabet JY, Clerc P, et al. Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes diagnostic accuracy and outcome implications. J Am Coll Cardiol. 2005; 46(2):302-9. doi: 10.1016/j.jacc.2005.03.064.
OA²Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S, et al. The role of imaging in chronic degenerative mitral regurgitation. JACC Cardiovasc Imaging. 2008; 1(2):221-37. doi: 10.1016/j.jcmg.2008.01.011.
Pepi M, Tamborini G, Maltagliati A, Galli CA, Sisillo E, Salvi L, et al. Head - to head comparison of two - and three - dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol. 2006; 48(12):2524-30. doi: 10.1016/j.jacc.2006.02.079.
Pizzaro R, Bazzino OO, Oberti RF, Falconi M, Achilli F, Arias A, et al. Prospective validation of the prognostic usefulness of brain natriuretic peptide in asyptomatic patients with chronic severe mitral regurgitation. J Am Coll Cardiol. 2009; 54(12): 1099-106. doi: 10.1016/j.jacc.2009.06.013.
Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, et al. Outcome of watchful waiting in asyptomatic severe mitral regurgitation. Circulation. 2006; 113(8):2238-44. doi: 10.1161/CIRCULATIONAHA.105.599175.
Russo A, Grigioni F, Avierinos JF, Freeman WK, Suri R, Michelena H, et al. Thromboembolic complications after surgical correction of mitral regurgitation incidence, predictors, and clinical implications. J Am Coll Cardiol. 2008;51(12):1203-11. doi: 10.1016/j.jacc.2007.10.058.
Schaff HV. Asymptomatic severe mitral valve regurgitation: observation ot operation? Circulation. 2009; 119(6): 768-9. doi: 10.1161/CIRCULATIONAHA.108.832626.
Suri RM, Schaff HV, Dearani JA, Sundt TM, Daly RC, Mullany CJ, et al. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. J Thorac cardiovasc Surg. 2009; 137(5):1071-6. doi: 10.1016/j.jtcvs.2008.10.026.
Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of European society of cardiology. Eur Heart J. 2007; 28(2):230-68. doi: 10.1093/eurheartj/ehl428.
Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc. Echocardiogr. 2003; 16(7):777-802. doi: 10.1016/S0894-7317(03)00335-3.
