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Interventional Mitral Annular Reduction Techniques

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Catheter Based Valve and Aortic Surgery

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Abstract

Mitral regurgitation (MR) is the second most frequent native valve disease, and its prevalence increases with age and cardiac comorbidities [1, 2]. Compared to the aortic valve, the anatomy and function of the mitral valve (MV) and its apparatus is more complex, and there are complicated interactions between the annulus, the leaflets, the subvalvular apparatus, and the left ventricle. There are two entities that should be defined and separated for both diagnosis and treatment: primary MR, with an abnormality of the MV itself being the reason for regurgitation which ultimately can cause left ventricle dysfunction, and secondary MR, where the MV leaflets are more or less normal and impairment and dysfunction of the valvular apparatus is caused by pathological left ventricular remodeling in presence of either ischemic heart disease or other forms of cardiomyopathy (Fig. 15.1) [3, 4]. Patients with secondary MR are often elderly with relevant comorbidities, increasing the risk for interventional or surgical MV therapy [5–8]. Current European and American guidelines recommend cardiac surgery in symptomatic patients with severe MR, as well as in asymptomatic patients with deteriorated left ventricular (LV) function and in asymptomatic patients with normal LV function when there is a high likelihood of successful surgical repair or other risk factors exist such as atrial fibrillation or pulmonary hypertension. Surgery may also be considered in patients with secondary MR in symptomatic patients after optimal medical management if bypass surgery is indicated [3, 4]. Stand-alone surgery in patients with secondary MR remains controversial and is indicated only in exceptional cases. Surgical reconstruction of the regurgitant valve has been considered superior over valve replacement, and restrictive annuloplasty has been the method of choice in most of these patients, although recent data cast doubts on this strategy [9–11].

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Authors and Affiliations

  1. Department of Cardiology, Pulmonology, Angiology, and Internal Intensive Care, University Hospital, University of Bonn, Sigmund-Freud Str. 25, NRW, Bonn, 53127, Germany

    Robert Schueler MD, Georg Nickenig MD & Christoph Hammersting MD

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  1. Robert Schueler MD
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Correspondence to Christoph Hammersting MD .

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Editors and Affiliations

  1. Department of Surgery, Advanced Cardiac Valve Center, Universit, Charlottesville, Virginia, USA

    Gorav Ailawadi

  2. Department of Surgery, University of Virginia, Charlottesville, Virginia, USA

    Irving L. Kron

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Schueler, R., Nickenig, G., Hammersting, C. (2016). Interventional Mitral Annular Reduction Techniques. In: Ailawadi, G., Kron, I. (eds) Catheter Based Valve and Aortic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3432-4_15

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  • DOI: https://doi.org/10.1007/978-1-4939-3432-4_15

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