Recent advances in understanding and managing mitral valve disease

Abstract

Interest in the mitral valve has increased over the past few years with the development of new technologies that allow intervention in patients previously deemed too ill for treatment. This increased attention has resulted in a significant increase in publications on the mitral valve, the majority of which focus on mitral regurgitation and mitral valve surgery/intervention. The focus of this review is on publications in the past few years that offer additional insights into our understanding and management of mitral valve disease and specifically mitral regurgitation. It will discuss mitral valve anatomy, epidemiology of mitral valve disease, changes in the 2017 management guidelines, management of mitral bioprosthetic valves, transcatheter mitral valve procedures and the repair of rheumatic valves.

Mitral valve disease: A view on pathophysiology and management of the most common valve disease in the world

“…Annular remodeling will vary depending on the pathophysiology of the underlying disease process. 13 Physiological degrees of mitral annular incoherence have been isolated in "normal" patients and whether this represents early signs of dysfunction or a mere physiological variant is yet to be determined. However, it is important to appreciate that, histologically, the annulus is a non -continuous structure and its thickness will vary depending on the density of collagen.…”

“…This could adversely affect outcomes for patients. 13 Case studies are expected to be published in the coming years (especially from the USA) and careful documentation of medical decisions and considerations would be advisable. Over time, the conduction of longitudinal studies should also shed some light on the issue.…”

Commentary: Rheumatic mitral valve repair: Where is the real word?

“…In these patients, mitral regurgitation is prevalent, and mitral stenosis (MS) is less frequent. 2 By contrast, in developed countries of the northern hemisphere, where rheumatic fever has been eradicated, we see older patients (typical mean age, 50-55 years) who had rheumatic fever 4 or 5 decades ago, whose pathology is a remnant of the acute process manifesting itself mostly as stenotic and thickened leaflet valves. In the former population, implantation of a prosthesis, whether mechanical or biological, represents a major problem because of increased thromboembolism and biodegradation.…”

Contemporary trends in mitral valve surgery in East China: a 10-year experience

“…As an important part of it, the level of surgical diagnosis and treatment of mitral valve disease have been continually improved. 1 The move from the traditional thoracotomy to mini-incisions and percutaneous minimally invasive surgery has been applied to mitral valve replacement (MVR) as well as various technologies for mitral valve repair (MVP). Although the leading etiology of mitral valve disease in East Asia is rheumatic fever, 2 with the change in people's lifestyle, improvements in medical treatment, and the extension of life-expectancy, the spectrum of mitral valve disease in China is now more similar to that in western countries.…”