Asymptomatic Severe Mitral Valve Regurgitation

Abstract

Management of patients with mitral valve regurgitation (MR) has changed dramatically over the past 20 years; this change is largely attributable to 3 factors. First, there have been significant improvements in operative techniques that have led to predictable and durable results after valve repair. In current practice at our clinic, >95% of patients with pure MR caused by degenerative diseases have valve repair rather than prosthetic replacement, and with modern, simplified methods of leaflet repair and annuloplasty, the risk of reoperation after correction of MR is no greater than that after mitral valve replacement.1 Article p 797 The second major shift in mitral valve disease is the change in pathology and pathophysiology of MR. In current practice, almost 80% of patients having mitral valve operations have pure regurgitation rather than valve stenosis or mixed regurgitation and stenosis, and the cause is most often degenerative or myxomatous disease; there is a declining frequency of postinflammatory disease in North America and many other areas of the world. The third important change in the management of patients with mitral valve disease is the better understanding of the natural history of MR, which has been made possible by both detailed natural history studies and improved techniques of 2-dimensional and Doppler echocardiography.2–4 The article by Kang et al5 in this issue of Circulation provides important new and confirmatory information on the outcome of asymptomatic patients with severe MR. Before the 1990s, most clinicians viewed MR as a relatively benign condition, and surgery was reserved for patients who were severely symptomatic or failed medical management.6,7 Reluctance to proceed with operation was related to the likelihood of prosthetic valve replacement and to the notion that asymptomatic patients with severe MR were a …