Egenerative mitral valve disease

Degenerative mitral valve (MV) disease is the most common form of organic non-ischemic MV regurgitation. Myxomatous degeneration commonly involves the annulus, the leaflets and the subvalvular apparatus. Three forms of degenerative mitral valve disease have been described based on the extent and degree of degenerative changes: Barlow's disease, Fibro elastic deficiency and Forme Froste. Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. The combination of symp-toms and echocardiographic assessment (severity of regurgitation, left ventricular size and function, left atrial size and pulmonary artery systolic pressure) guides the timing of surgical intervention. MV replacement with either a biologic or mechanical prosthesis used to be the standard of care for surgical treatment of degenerative MV regurgitation. A variety of MV repair techniques have been developed with a success rate of 90% in expert hands at high volume centers. The choice of specific repair technique is based on the segmental analysis of the mitral valve preoperatively using Echocardiography and intra-operatively by direct visualization. The results of surgical treatment of degenerative mitral valve disease are dependent on the extent of the disease, technique used and the preoperative ventricular function. We review in this chapter the pathophysiology of degenerative mitral valve regurgitation, its natural history and echocardiographic assessment of mitral regurgitation caused by degenerative MV disease. This review discusses also different surgical techniques used to treat degenerative MV regurgitation and the results of these techniques supported by up to date review of the literature.