ABSTRACT

Mitral valve disease affects an estimated 2.5 million people in the United States, a number that is expected to double by 2030 (1). With this disease prevalence, mitral valve surgery constitutes up to one-third of all cardiac procedures. When evaluating mitral disease, regurgitation and stenosis are considered separately. For the purposes of this text, the focus will be on mitral regurgitation (MR). MR can be subdivided into categories based on the underlying pathology. Primary or “degenerative” disease broadly defi nes pathology affecting the valve leafl ets and chordae. This is also referred to as “structural” mitral valve disease. Primary MR affects approximately 2% of the population and is the most common type of MR encountered in the surgical setting. Secondary or “functional” disease results from valve misalignment caused by a shift in the geometry of the left ventricle. Changes in the left ventricular geometry occur with either local remodeling of the ventricle due to an infarct or global remodeling due to dilated cardiomyopathy. In particular, MR is often observed after an inferior or posterior infarct causing malalignment of the papillary muscles and tethering of the mitral leafl ets. Changes in the ventricular geometry also result in annular dilation, which exacerbates MR.