The pathophysiology of mitral regurgitation

The results of treatment of heart valve disease have improved steadily duri ng the past 20 years. In aortic stenosis,although postoperative survival ra tes approximated those of age-matched controls, the outcome of surgery to t reat ischemic and non-ischemic mitral regurgitation was grave. The reasons for this were two-fold: first, patients were referred for surgery late in t he course of their disease, when irreversible left ventricular (LV) dysfunc tion prevented postoperative restoration of contractile function. Second, t he value of the mitral Valve apparatus in facilitating LV contraction was u nrecognized, and this structure was often removed at surgery, in turn worse ning pre-existent LV dysfunction. Consequently, patients with LV dysfunctio n due to mitral regurgitation underwent surgery that caused further damage to the left ventricle. Not surprisingly, postoperative LV function was poor , congestive heart failure persistent, and lifespan shortened. More recentl y, however, substantial insight has been gained into the value of the mitra l valve apparatus, the causes of LV dysfunction in mitral regurgitation, an d into the objective markers of LV function that permit the clinician to re commend surgery before muscle dysfunction has become severe and irreversibl e.