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(Circulation. 2006;113:2169-2172.)
© 2006 American Heart Association, Inc.

Editorial

Timing of Surgical Intervention in Chronic Mitral Regurgitation

Is Vigilance Enough?

Brian P. Griffin, MD

From the Section of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Brian P. Griffin, MD, F-15 Cardiology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail griffib@ccf.org

Key Words: Editorials • echocardiography • mitral valve • regurgitation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Timing of surgical intervention in chronic mitral regurgitation (MR) is a complex problem that has been studied extensively. Surgical technique in the treatment of MR has improved considerably over the last decades. Our knowledge of the pathophysiological mechanisms whereby MR exerts its deleterious effects on survival has also increased. Early reports in the literature and newer prospective studies suggest that severe MR is not a benign condition and that, left untreated, it has a high morbidity and eventually mortality. It therefore makes sense to periodically reexamine the rationale and safety of existing practice guidelines. The article by Rosenhek and colleagues¹ in this issue of Circulation provides an interesting and important insight into the long-term outcomes when asymptomatic degenerative MR is managed in accordance with the current American College of Cardiology/American Heart Association guidelines.² However, it is important in employing these guidelines to first understand the pathophysiological construct and studies that have led to their generation.

Article p 2238

	Pathophysiological Effects of MR

 
MR produces volume overload of the left ventricle and left atrium. The left ventricle develops eccentric hypertrophy whereby the sarcomeres elongate. Preload increases and the left ventricle dilates in order to maintain a normal forward flow. The increase in afterload resulting from left ventricular dilatation is offset by the fact that the ventricle is pumping much of its volume (regurgitant volume) into a low-impedance circuit (the left atrium). Therefore, afterload may be variably reduced initially in MR and typically only becomes elevated in later stages of the disease as left ventricular size . . . [Full Text of this Article]

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				J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012. [Full Text]

				For Asymptomatic Severe MR, Watch and Wait? Journal Watch Cardiology, June 28, 2006; 2006(628): 3 - 3. [Full Text]