Imaging Challenges in Secondary Mitral Regurgitation

Quantitative Three-Dimensional Color Flow Echocardiography of Chronic Mitral Regurgitation: New Methods, New Perspectives, New Challenges

“…15 Additionally, the FCR of the MR jet from the same data can be used to measure 3D EROA by the 3D PISA or the 3D FOM to further increase the reliability of grading the severity of MR. Finally, 3D VCA can be measured for a comprehensive quantitation of MR. Real-time (nongated) volume imaging will mean that these 3D CFD techniques can also be used in patients with chronic MR and atrial fibrillation, in whom CMR cannot be used.…”

“…Ultimately, the predictive value of this integrated approach will have to be tested in prospective multicenter studies with clinical events as end points, such as the Progression and Outcome of Secondary Mitral Regurgitation study (POMAR). 15 This study will test the accuracy of automated 3D PISA and stroke volume methods and will examine the incremental value of 3D quantitation in predicting clinical outcomes compared with CMR. An additional question to be answered is when and how CMR incrementally complements the integrated assessment of MR severity using these newer 3D echocardiographic approaches.…”

Therapeutic decision-making for patients with fluctuating mitral regurgitation

“…19 Secondary MR results from the geometrical distortion of the subval vular apparatus, which occurs secondary to LV enlarge ment and impaired contractility. 3,4,20,21 Secondary MR is a disease of the ventricles rather than of the valves per se, and is classified as type IIIb in Carpentier's surgical clas sification of mitral valve pathology. 11,22 The incidence and clinical importance of secondary MR is largely underestimated, in part owing to the insensitive nature of the physical examination.…”

“…1,2 MR is dynamic, with physio logical fluctuations occurring in response to haemo dynamic changes in the cardiocirculatory system, which can precipitate the development of symptoms and subse quent cardiac events. [4][5][6] The dynamic nature of MR has been investigated in patients with various acute cardiac conditions, particularly those with chronic degenera tive or secondary MR. 7,8 Stress echocardiography has an important role in the evaluation of fluctuating MR by providing new prognostic insights and risk stratifica tion parameters, which can help to define the optimal timing of intervention. [9][10][11][12] In this Review, we discuss the characteristics of dynamic MR and the potential mecha nisms underlying its development, as well as the optimal s trategies to treat the condition.…”

A Comparison of 2 Mitral Annuloplasty Rings for Severe Ischemic Mitral Regurgitation: Clinical and Echocardiographic Outcomes

“…1 When dealing with IMR, echocardiography plays a major role in identifying the types of leaflet tethering and the change of mitral valve apparatus geometry. 2 Annular dimension, coaptation depth (CD), tenting area (TA) or volume, interpapillary distance, and leaflet angles are the most important echocardiographic parameters to report, representing predictors of recurrent MR after restrictive mitral valve annuloplasty (MVA). 2 To date, restrictive MVA represents the most performed techniques used to treat patients with secondary MR. 3 Several studies have shown that the recurrence of MR at 1-year remains high (10%-30%).…”