Prof. Nawwar Al-Attar
Mitral regurgitation (MR) is commonly associated with aortic stenosis and can be present in up to 50%. It is basically of 2 types : functional and organic. Mitral valve (MV) surgery is associated with better survival if the grade of MR is severe. MV repair gives superior outcomes. The success of repair depends on the etiology of MR with rheumatic valves having the greatest incidence of repeat valve surgery after initial repair. The predictors of worse postoperative MR are : LA diameter, PAP, and extensive mitral calcification, as explained by P. Tornos Mas (Spain).
In the second presentation, Dr. Kappetein (Netherlands) explained that the presence of ischemia reduces survival and ischemic MR is divided into acute (1-3%, 2-7 days following acute myocardial infarction with high mortality) and chronic (basically due to left ventricular (LV) remodelling). A left ventricular end diastolic diameter >65 mm is an indicator of poor prognosis.
Next, Bernard Iung (Paris, France) showed that LV ejection fraction is a strong predictor of 10 year survival in MR with flail leaflets. A very low EF (<30%) is more strongly associated with poor long term outcomes than with high operative mortality, despite the increased risk. Moreover, these patients have more comorbidities. The guidelines advise surgery if patients are symptomatic and refractory to medical treatment. The assessment of LV viability plays a major role in the indication for surgery and predicts recovery of LV function. Again, repair should be privileged over replacement. LVEDD and LVEDS are also important and should be taken into consideration.
Lastly, R Dion from Belgium spoke about the surgical treatment of mitral regurgitation in endocarditis. Early repair gives the best results in patients with MV endocarditis. It reduces incidence of relapse, stroke, and need for further surgical treatment. Successful repair is associated with good remodelling postoperatively.
In this session, prestigious speakers gave a clear message about managing difficult mitral problems. An interactive audience made the session quite interesting and a take home message made attendees happy to attack another day of the ESC congress.
Difficult mitral valve problems
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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