TREATMENT OF CHRONIC MITRAL REGURGITATION

Background Chronic, severe mitral regurgitation is a common clinical e ntity that can lead to progressive, irreversible left ventricular dysf unction. New information on the natural history of this condition, cou pled with advances in surgical technique, have changed the roles of me dical and surgical therapies. Methods The current medical and surgical literature regarding chronic mitral regurgitation is critically revie wed. Results There is no well-defined role for medical therapy in chro nic mitral regurgitation. The goal of the treating physician is theref ore to choose the optimal timing for surgical intervention. This proce ss begins with noninvasive quantification of the degree of regurgitati on. If severe, a careful search for signs or symptoms of impending lef t ventricular dysfunction should follow. Recent advances in surgical t echniques for mitral valve repair allow for correction of the valvular defect with minimal mortality risk and improved preservation of ventr icular function and are an impetus for early operative intervention. M itral valve repair may also be beneficial in the setting of severe dil ated cardiomyopathy. Conclusions The development of techniques for mit ral valve repair has altered the treatment paradigm for severe mitral regurgitation. Surgical intervention before the onset of left ventricu lar dysfunction is recommended.