Chronic Mitral Regurgitation : Optimal time to Intervention


Chronic mitral regurgitation is commonly encountered valve disease. In this disease, there is volume overload on the left ventricle leading to left ventricle dilatation and dysfuction. Surgical or percutaneous intervention can improve prognosis, however optimal timing of intervention still controversial. In the past, timing of intervention was based solely on symptoms and left ventricle function. There have been recent advances in our knowledge, diagnosis, and treatment of mitral regurgitation. All of these advances have provided an incentive to change the indication for timing of operations in patients with mitral regurgitation, setting a new paradigm of an early operation before the onset of ventricular dysfunction. In this article we will outline these newer advances and provide recommendations regarding optimal timing of intervention for mitral regurgitation.


Download data is not yet available.


1. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 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 (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. Sep 23 2008;52(13):e1-142.

2. Enriquez-Sarano M, Orszulak TA, Schaff HV, Abel MD, Tajik AJ, Frye RL. Mitral regurgitation: a new clinical perspective. Mayo Clin Proc. Nov 1997;72(11):1034-43.

3. Fowler NO, van der Bel-Kahn JM. Indications for surgical replacement of the mitral valve. With particular reference to common and uncommon causes of mitral regurgitation. Am J Cardiol. Jul 1979;44(1):148-57.

4. Nishimura R, Schaff HV. Mitral Regurgitation: Timing of Surgery. In: Bonow RO, Otto CM, eds. Valvular heart disease : a companion to Braunwald’s heart disease. Fourth edition. ed. Philadelphia: Saunders; 2009:p.

5. Enriquez-Sarano M, Schaff HV, Frye RL. Early surgery for mitral regurgitation: the advantages of youth. Circulation. Dec 16 1997;96(12):4121-3.

6. Ling LH, Enriquez-Sarano M, Seward JB, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. Nov 7 1996;335(19):1417-23.

7. Gaasch WH, John RM, Aurigemma GP. Managing asymptomatic patients with chronic mitral regurgitation. Chest. Sep 1995;108(3):842-7.

8. Gaasch WH, Zile MR. Left ventricular function after surgical correction of chronic mitral regurgitation. Eur Heart J. Jul 1991;12 Suppl B:48-51.

9. Ross J, Jr. The timing of surgery for severe mitral regurgitation. N Engl J Med. Nov 7 1996;335(19):1456-8.

10. Schaff HV, Suri RM, Enriquez-Sarano M. Indications for surgery in degenerative mitral valve disease. Semin Thorac Cardiovasc Surg. Summer 2007;19(2):97-102.

11. Tamburino C, Ussia GP, Maisano F, et al. Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting. Eur Heart J. Jun 2010;31(11):1382-9.

12. Feldman T, Kar S, Rinaldi M, et al. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. Aug 18 2009;54(8):686-94.

13. Savage EB, Ferguson TB, Jr., DiSesa VJ. Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg. Mar 2003;75(3):820-5.

14. Tribouilloy CM, Enriquez-Sarano M, Schaff HV, et al. Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications. Circulation. Jan 26 1999;99(3):400-5.

15. Chua YL, Schaff HV, Orszulak TA, Morris JJ. Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty? J Thorac Cardiovasc Surg. Feb 1994;107(2):408-15.

16. Grigioni F, Avierinos JF, Ling LH, et al. Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J Am Coll Cardiol. Jul 3 2002;40(1):84-92.

17. Dion R. Ischemic mitral regurgitation: when and how should it be corrected? J Heart Valve Dis. Sep 1993;2(5):536-43.

18. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. Apr 3 2001;103(13):1759-64.

19. Grossi EA, Crooke GA. Mitral valve surgery in heart failure: insights from the Acorn clinical trial. J Thorac Cardiovasc Surg. Sep 2006;132(3):455-6.

20. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline 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. Circulation. Mar 3 2014.

21. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. Oct 2012;33(19):2451-96.
Views & Downloads
Abstract views: 282   
PDF downloads: 419   
How to Cite
Chronic Mitral Regurgitation : Optimal time to Intervention. (2016). Indonesian Journal of Cardiology, 36(2), 111-9.
Review Article