Functional anatomy and echocardiographic assessment in secondary mitral regurgitation

Angela Nogara*, Alberto Minacapelli, Giulia Zambelli, Valeria Lo Coco, Khalil Fattouch

*Corresponding author for this work

Research output: Contribution to journalEditorialAcademicpeer-review


BACKGROUND: Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation.

AIM OF THE STUDY: The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with three-dimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve.

CONCLUSIONS: Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.

Original languageEnglish
Pages (from-to)4103-4111
Number of pages9
JournalJournal of Cardiac Surgery
Issue number12
Early online date23 Aug 2022
Publication statusPublished - Dec 2022

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