Journal ArticleDOI
Quantitative determinants of the outcome of asymptomatic mitral regurgitation
Maurice Enriquez-Sarano,Jean François Avierinos,David Messika-Zeitoun,Delphine Detaint,Maryann Capps,Vuyisile T. Nkomo,Christopher G. Scott,Hartzell V. Schaff,A. Jamil Tajik +8 more
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TLDR
Quantitative grading of mitral Regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation and patients with an effective regurgitant orifice of at least 40 mm2 should promptly be considered for cardiac surgery.Abstract:
background The clinical outcome of asymptomatic mitral regurgitation is poorly defined, and the treatment is uncertain. We studied the effect on the outcome of quantifying mitral regurgitation according to recent guidelines. methods We prospectively enrolled 456 patients (mean [±SD] age, 63±14 years; 63 percent men; ejection fraction, 70±8 percent) with asymptomatic organic mitral regurgitation, quantified according to current recommendations (regurgitant volume, 66±40 ml per beat; effective regurgitant orifice, 40±27 mm 2 ). results The estimated five-year rates (±SE) of death from any cause, death from cardiac causes, and cardiac events (death from cardiac causes, heart failure, or new atrial fibrillation) with medical management were 22±3 percent, 14±3 percent, and 33±3 percent, respectively. Independent determinants of survival were increasing age, the presence of diabetes, and increasing effective regurgitant orifice (adjusted risk ratio per 10-mm 2 increment, 1.18; 95 percent confidence interval, 1.06 to 1.30; P<0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 had a five-year survival rate that was lower than expected on the basis of U.S. Census data (58±9 percent vs. 78 percent, P=0.03). As compared with patients with a regurgitant orifice of less than 20 mm 2 , those with an orifice of at least 40 mm 2 had an increased risk of death from any cause (adjusted risk ratio, 2.90; 95 percent confidence interval, 1.33 to 6.32; P<0.01), death from cardiac causes (adjusted risk ratio, 5.21; 95 percent confidence interval, 1.98 to 14.40; P<0.01), and cardiac events (adjusted risk ratio, 5.66; 95 percent confidence interval, 3.07 to 10.56; P<0.01). Cardiac surgery was ultimately performed in 232 patients and was independently associated with improved survival (adjusted risk ratio, 0.28; 95 percent confidence interval, 0.14 to 0.55; P<0.01). conclusions Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 should promptly be considered for cardiac surgery.read more
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Review of mitral valve insufficiency: repair or replacement
Athanasios Madesis,Kosmas Tsakiridis,Paul Zarogoulidis,Nikolaos Katsikogiannis,Nikolaos Machairiotis,Ioanna Kougioumtzi,George Kesisis,Theodora Tsiouda,Thomas Beleveslis,Alexander Koletas,Konstantinos Zarogoulidis +10 more
TL;DR: This review will focus on the surgical management of mitral insufficiency according to its aetiology today and will give insight to some of the perspectives that lay in the future.
Journal ArticleDOI
Transcatheter Therapy of Mitral Regurgitation
TL;DR: Surgery is associated with mortality rates of 1% to 5% and morbidity rates of 10% to 20%, including stroke, reoperation, renal failure, and prolonged ventilation; mortality in octogenarians may be as high as 17% with morbidity occurring in more than a third of patients.
Journal ArticleDOI
Functional mitral regurgitation
Jan D. Schmitto,Lawrence S. Lee,Suyog A. Mokashi,Ralph Morton Bolman,Lawrence H. Cohn,Frederick Y. Chen +5 more
TL;DR: This article defined functional MR as a systolic retrograde flow from the left ventricle into the left atrium due to reduction and/or elimination of the normal syStolic coaptation of the mitral valve leaflets.
Journal ArticleDOI
Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions
Gloria Tamborini,Manuela Muratori,Anna Maltagliati,Claudia Galli,Moreno Naliato,Marco Zanobini,Francesco Alamanni,Luca Salvi,Erminio Sisillo,Cesare Fiorentini,Mauro Pepi +10 more
TL;DR: Three-dimensional TTE is feasible, not time-consuming, and accurate in identifying cases with simple vs. complex MV lesions and allowed an accurate identification of all MV lesions.
Journal ArticleDOI
The Time Has Come to Define Centers of Excellence in Mitral Valve Repair.
Robert O. Bonow,David H. Adams +1 more
TL;DR: Advances in surgical repair of the mitral valve have revolutionized the management of patients with primary degenerative forms of mitral regurgitation, rather than waiting for symptoms or objective clinical endpoints of left ventricular dysfunction, pulmonary hypertension, or atrial hypertension.
References
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Journal ArticleDOI
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography
William A. Zoghbi,Maurice Enriquez-Sarano,Elyse Foster,Paul A. Grayburn,Carol D. Kraft,Robert A. Levine,Petros Nihoyannopoulos,Catherine M Otto,Miguel A. Quinones,Harry Rakowski,William J. Stewart,Alan D. Waggoner,Neil J. Weissman +12 more
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