Abstract
Primary mitral regurgitation (MR) is the second most common valvular disease, characterized by a high burden in terms of quality of life, morbidity, and mortality. Surgical treatment is considered the best therapeutic strategy for patients with severe MR, especially if they are symptomatic. However, pre-operative echocardiographic evaluation is an essential step not only for surgical candidate selection but also to avoid post-operative complications. Therefore, a strong collaboration between cardiologists and cardiac surgeons is fundamental in this setting. A meticulous pre-operative echocardiographic exam, both with transthoracic or transesophageal echocardiography, followed by a precise report containing anatomical information and parameters should always be performed to optimize surgical planning. Moreover, intraoperative transesophageal evaluation is often required by cardiac surgeons as it may offer additive important information with different hemodynamic conditions. Three-dimensional echocardiography has recently gained higher consideration and availability for the evaluation of MR, providing more insights into mitral valve geometry and MR mechanism. This review paper aims to realize a practical overview on the main use of basic and advanced echocardiography in MR surgical planning and to provide a precise checklist with reference parameters to follow when performing pre-operative echocardiographic exam, in order to aid cardiologists to provide a complete echocardiographic evaluation for MR operation planning from clinical and surgical point-of-view.
Highlights
IntroductionMitral regurgitation (MR) is the second most common valvular heart disease (after aortic stenosis), and the second most frequent indications for cardiac surgery
Mitral regurgitation (MR) is the second most common valvular heart disease, and the second most frequent indications for cardiac surgery
The present review aims to describe the pivotal elements for the correct planning of mitral regurgitation (MR) surgery analyzing the echocardiographer and cardiac surgeons’ points of view, in order to assist clinicians in the use of traditional and newest echocardiographic techniques preoperative MR evaluation
Summary
Mitral regurgitation (MR) is the second most common valvular heart disease (after aortic stenosis), and the second most frequent indications for cardiac surgery. American guidelines recommend mitral valve (MV) surgery for symptomatic patients with chronic severe primary MR or asymptomatic patients with LV dysfunction (assessed with LV EF 30–60% and/or LV end-systolic diameter >40 mm) [2]. When the patient has been referred for surgical treatment of MR, a meticulous planning of the intervention is the cornerstone for its success. At this stage, a close collaboration between the cardiologist and the cardiac surgeon is paramount to facilitate the surgical procedure and to ensure patient the best management
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