ABSTRACT
Secondary mitral regurgitation (SMR) is relatively frequent. It occurs in roughly 20%–25% of patients following myocardial infarction (MI) and 50% of those with chronic heart failure.1 Any degree of SMR in patients with left ventricular (LV) dysfunction conveys adverse prognosis, with a graded relationship between severity of regurgitation and reduced survival .2 Moreover, the increase in the prevalence of both MI and chronic heart failure in the last decades is likely to lead to an increase in the prevalence of SMR. Surgical techniques used for mitral valve (MV) repair (i.e., undersized annuloplasty) are not able to abolish SMR in most patients.3,4 Recurrence of SMR after undersized annuloplasty has been reported in as much as 60% of them.3 A better understanding of the complex three-dimensional (3D) morphology of the MV before surgery in each individual patient, possible today with the use of 3D echocardiography, might improve surgical results after MV repair. Threedimensional echocardiography is superior to 2D echocardiography in the assessment of the morphology of the MV apparatus because it does not depend on mental reconstruction of the gathered images and allows direct visualization of the MV morphology from any angle. Lately, some interesting animal studies using 3D echocardiography and addressing the mechanisms of SMR, came up with innovative solutions that effi ciently reduced the severity of SMR.5-7 Hence, 3D echocardiography is a very useful tool in the evaluation of patients with SMR, especially when MV repair is contemplated.
