Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2003 Jan;89(1):100-5.
doi: 10.1136/heart.89.1.100.

Timing of surgery in mitral regurgitation

Catherine M Otto  1
Affiliations
Review

Timing of surgery in mitral regurgitation

Catherine M Otto. Heart. 2003 Jan.
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Normal function of the mitral valve apparatus depends on normal anatomy and function of the mitral annulus, the anterior and posterior leaflets, chordae, papillary muscles and the size, shape and systolic performance of the left ventricle. Reproduced with permission from: Otto CM. Valvular heart disease. Philadelphia: WB Saunders, 1999.
Figure 2
Figure 2
In a 55 year old man with an asymptomatic systolic murmur, echocardiographic images at end diastole (left) and end systole (centre) in a long axis view, show thickening and redundancy of the posterior mitral leaflet with prolapse of both leaflets into the left atrium in systole. Colour flow imaging (right) shows a large area of regurgitation. However, left ventricular size is normal with an end systolic dimension of 25 mm, ejection fraction is 62%, left atrial size is only mildly increased, and pulmonary pressures are normal. His physician is following the patient with annual echocardiography. Ao, aorta; LA, left atrium; LV, left ventricle.
Figure 3
Figure 3
This 23 year old woman with recurrent postpartum atrial flutter and a systolic murmur has systolic prolapse of the posterior leaflet (left), although the leaflets are normal in thickness. There is an eccentric anteriorly directed jet of mitral regurgitation on colour flow imaging (right) consistent with posterior leaflet prolapse. Her left ventricular end systolic dimension, ejection fraction, and pulmonary pressures are normal. Left atrial size is mildly increased.
Figure 4
Figure 4
Schematic diagram of a mitral valve repair procedure. A quadrangular resection of the redundant or flail segment of the posterior leaflet is performed (A) and the posterior leaflet is detached from the annulus (sliding leaflet technique). The remaining posterior leaflet tissue is brought together, the resection is sutured, and the posterior leaflet is reattached to the annulus with placement of a flexible posterior annuloplasty ring (B). Reproduced with permission from: Gillinov AM, Cosgrove DM. Ann Thoracic Surgery 1999;68:2356–7.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Otto CM. Valvular regurgitation: diagnosis, quantitation and clinical approach. In: Otto CM, ed. Textbook of clinical echocardiography, 2nd ed. Philadelphia: WB Saunders, 2000:265–300. ▸ Basic echocardiographic approach to evaluation of mitral valve anatomy a nd evaluation of regurgitant severity.
    1. Bonow RO, Carabello BA, deLeon AC, et al. ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of patients with valvular heart disease). J Am Coll Cardiol 1998;32:1486–8. ▸ Consensus guidelines on the optimal management of patients with valvar heart disease. Concise summary of the literature and extensive list of references. - PubMed
    1. Otto CM. Evaluation and management of chronic mitral regurgitation. N Engl J Med 2001;345:740–6. ▸ Recent review summarising the strategies and evidence for management of chronic mitral regurgitation. A flow chart summarising the ACC/AHA guidelines and 25 key references are included. - PubMed
    1. Meier DJ, Landolfo CL, Starling MR. The role of echocardiography in the timing of surgical intervention for chronic aortic and mitral regurgitation. In: Otto CM, ed. The practice of clinical echocardiography, 2nd ed. Philadelphia: WB Saunders, 2002. ▸ Detailed review of the evidence for determining the optimal timing of surgical intervention for mitral regurgitation. Practical algorithm for clinical use is provided.
    1. Duren DR, Becker AE, Dunning AJ. Long-term follow-up of idiopathic mitral valve prolapse in 300 patients: a prospective study. J Am Coll Cardiol 1988;11:42–7. ▸ In this classic prospective study including patients with varying degrees of mitral regurgitation caused by mitral prolapse, the natural history of the disease was slow with a survival rate of 97% at six years. - PubMed