Secondary (Functional) Mitral Regurgitation

Ioannis A. Paraskevaidis ‘Αττικόν’ University Hospital

Primary MR, the pathology of ≥1 of the components of the valve (leaflets, chordae tendineae, papillary muscles, annulus) causes valve incompetence.

Secondary MR, MR is only 1 component of the disease (severe LV dysfunction, coronary disease, or idiopathic myocardial disease are the others), restoration of mitral valve competence is not by itself curative.

J.P. Dal-Bianco et al,. Canadian Journal of Cardiology 2014;30:971e- 981

Silbiger JJ., JASE 2013;26:1107-17

Valvular – Ventricular Complex

K Kalra et al,. JACC 2014;64:1867–79

Magne J et al,. JASE 2013;10:1130-34

Secondary MR Time to Look Beyond EF

Geometric Distortions Valvular – Ventricular Complex

Closing forces reflect the pressure generated by the contracting LV

Reduction of LV contractility •Global LV dyssynchrony •PM dyssynchrony •Altered systolic mitral annulus contraction

Tethering forces are dependent on and transmitted via the LV wall- PM-chordae system Annular dilatation •LV dilatation •PM Displacement •LV shericity

Lung B. Heart 2003;89;459-464, JP. Dal-Bianco et al,. Canadian Journal of Cardiology 2014;30:971e- 981

Geometric Distortions Valvular – Ventricular Complex

Ventricular – Valve Interaction in Ischemic MR

JHung et al,. J Heart Valve Dis. 2012; 21: 218–24)K Kalra et al,. JACC 2014;64:1867–79

Percutaneous v.s Surgery

L. Mauri et al,. ,EVEREST II, JACC 2013;62:317–28 A.W. Asgar et al,. JACC 2015;65:1231–48

J.P. Dal-Bianco et al,. Canadian Journal of Cardiology 2014;30:971e- 981