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The Role of Imaging in Chronic Degenerative Mitral Regurgitation

Patrick O’Gara, MD, FACC^_*, Lissa Sugeng, MD, FACC, Roberto Lang, MD, FACC, Maurice Sarano, MD, FACC, Judy Hung, MD, FACC^¶, Subha Raman, MD, FACC^||, Gregory Fischer, MD, Blasé Carabello, MD, FACC^_**, David Adams, MD, FACC, Mani Vannan, MBBS, FACC^||,_*

^_* Brigham And Women’s Hospital, Boston, Massachusetts
Mount Sinai Medical Center, New York, New York
University of Chicago Hospitals, Chicago, Illinois
Mayo Clinic, Rochester, Minnesota
^¶ Massachusetts General Hospital, Boston, Massachusetts
^|| Ohio State University Medical Center, Columbus, Ohio
^_** Veterans Affairs Medical Center, Houston, Texas.

^_* Reprint requests and correspondence: Dr. Mani A. Vannan, The Ohio State University, 473 West 12th Avenue, DHLRI, Suite 200, Columbus, Ohio 43210. (Email: mani.vannan{at}osumc.edu).

Chronic degenerative mitral regurgitation (MR) is a complex problem, which requires an integrated assessment of etiology, pathophysiology, and severity to enable informed clinical decision-making. A multidisciplinary approach is required, with input from the clinician, imager, and surgeon. This review begins with a discussion of essential echocardiographic and surgical mitral valve (MV) anatomy, which dictates suitability for repair when indicated. The echocardiographic and Doppler principles, which underlie the quantitation of MR severity, are summarized in the next section, followed by a critical examination of left ventricular systolic function in this disorder. A brief discussion of the important role of imaging in the developing field of percutaneous MV repair is included. The methodical and objective noninvasive assessment of degenerative MR herein reviewed is intended to help guide management decisions for patients with this challenging valve lesion.

Abbreviations and Acronyms   AML = anterior mitral leaflet   CMR = cardiac magnetic resonance   CS = coronary sinue   EDV = end-diastolic volume   EF = ejection fraction   ERO = effective regurgitant orifice area   ESD = end-systolic dimension   ESV = end-systolic volume   GCV = great cardiac vein   LA = left atrium   LV = left ventricular   MR = mitral regurgitation   MV = mitral valve   PISA = proximal isovelocity surface area   PML = posterior mitral leaflet   RF = regurgitant fraction   RVol = regurgitant volume   SV = stroke volume   TEE = transesophageal echocardiography

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