What is it about?

A leaking mitral valve due to heart pump abnormalities is an increasingly common problem and is associated with poor long term survival. Until recently, no surgical or less invasive catheter treatment had improved survival and this may have been due to challenges in assessing the severity of the valve leak, and due to selecting patients whose heart failure condition was already too advanced. This review article goes through what is already known on how common the problem it, how it arises and the challenges in assessing severity. We discuss the recent studies, and new approaches to understanding the severity of the valve leak in a way that incorporates the overall heart failure condition of the patient. We also look ahead at future studies that will help evolve understanding and treatment with the aim of improving patient outcomes in this challenging condition.

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Why is it important?

We are at an important junction in our understanding and the of mitral regurgitation due to heart failure (secondary mitral regurgitation). For many years the broad consensus was that this condition would not respond to invasive measures to repair the valve and that tablets for heart failure was the main treatment strategy. There is now evidence to suggest that in a select group of patients, minimally invasive catheter based mitral valve repair leads to significant improvements in patient survival and rate of hospitalisation. This has provoked a lot of debate regarding how we identify patients who stand to benefit from such treatments and refine our understanding of the close interlinked relationship between the heart failure and the mitral valve leak. This article serves to highlight this relationship whilst also looking at how we can better select patients for invasive treatment in order to improve survival.

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This page is a summary of: Secondary mitral regurgitation: pathophysiology, proportionality and prognosis, Heart, February 2020, BMJ, DOI: 10.1136/heartjnl-2019-316238.
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