Abstract
Secondary MR is a complication of end-stage cardiomyopathy and is associated with a poor prognosis and is due to progressive mitral annular dilation and alteration in LV geometry. A vicious cycle of continuing volume overload, ventricular dilation, progression of annular dilation, increased LV wall tension and worsening MR and CHF occur. The mainstay of medical therapy is diuretics and afterload reduction, and is associated with poor long-term survival in these patients with CHF and MR. However, surgical intervention in the form of undersized, ‘overcorrecting’ mitral valve repair has shown great promise and is an area of ongoing investigation.
Similar content being viewed by others
References
Boltwood CM, Tei C, Wong M, Shah PM. Quantitative echocardiography of the mitral complex in dilated cardiomyopathy: the mechanism of functional mitral regurgitation. Circulation 1983;68(3):498–508.
Stevenson LW, Fowler MB, Schroeder JS, Stevenson WG, Dracup KA, Fond V. Poor survival of patients with idiopathic cardiomyopathy considered too well for transplantation. Am J Medicine 1987;83(5):871–876.
Rosario LB, Stevenson LW, Solomon SD, Lee RT, Reimold SC. The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size. J Am Coll Cardiol 1998;32:1819–1824.
Fann JI, Ingels NB, Miller DC. Pathophysiology of mitral valve disease and operative indications. In: Edmunds LH, ed. Cardiac Surgery in the Adult. NY: McGraw-Hill, 1997:959–990.
Starling MR, Kirsh MM, Montgomery DG, Gross MD. Impaired left ventricular contractile function in patients with long-term mitral regurgitation and normal ejection fraction. J Am Coll Cardiol 1993;22(1):239–250.
Carabello BA, Williams H, Gash AK, Kent R, Belber D, Maurer A, Siegel J, Blasius K, Spann JF. Hemodynamic predictors of outcome in patients undergoing valve replacement. Circulation 1986;74(6):1309–1316.
Akasaka T, Yoshida K, Hozumi T, Takagi T, Kaji S, Kawamoto T, Ueda Y, Okada Y, Morioka S, Yoshikawa J. Restricted coronary flow reserve in patients with mitral regurgitation improves after mitral reconstructive surgery. J Am Coll Cardiol 1998;32:1923–1930.
Bristow MR, Ginsburg R, Minobe W, Cubicciotti RS, Sageman WS, Lurie K, Billingham ME, Harrison DE, Stinson EB. Decreased catecholamine sensitivity and beta-adrenergic receptor density in failing human hearts. N Engl J Med 1982;307:205–211.
Kawaguchi HK, Kitabatake A. Alterations of signal transduction system in heart failure. Japan Heart J 1997;38:317–332.
Harding SE, Brown LA, Wynne DG, Davies CH, Poole-Wilson PA. Mechanisms of β adrenoceptor desensitization in the failing human heart. Cardiovasc Res 1994;28:1451–1460.
Torre-Amione G, Kapadia S, Benedict C, Oral H, Young JB, Mann DL. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the Studies of Left Ventricular Dysfunction (SOLVD), J Am Coll Cardiol 1996:27(5):1201–1206.
Herrera-Garza EH, Stetson SJ, Cubillos-Garzon A, Vooletich MT, Farmer JA, Torre-Amione G. Tumor necrosis factor-α: A mediator of disease progression in the failing human heart. Chest 1999;115:1170–1174.
Thomas, JD. How leaky is that mitral valve? Simplified Doppler methods to measure regurgitant orifice area. Circulation 1997;93(3):548–550.
Sarris GE, Cahill PD, Hansen DE, Derby GC, Miller DC. Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. The importance of valvular-ventricular interaction. J Thorac Cardiovasc Surg 1988;95(6):969–979.
David TE, Uden DE, Strauss HD. The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 1983;68(3 pt 2):1176–1182.
Huikuri HV. Effect of mitral valve replacement on left ventricular function in mitral regurgitation. Br Heart J 1983;49(4):328–333.
Tischler MD, Cooper KA, Rowen M, LeWinter MM. Myocardial function/valvular heart disease/hypertensive heart disease: mitral valve replacement versus mitral valve repair: a Doppler and quantitative stress echocardiographic study. Circulation 1994;89(1):132–137.
Akins CW, Hilgenberg AD, Buckley MJ, Vlahakes GJ, Torchiana DF, Daggett WM, Austen WG. Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg 1994;58:668–676.
Batista R. Partial left ventriculectomy — the Batista procedure. Thorac Surg 1999;15(suppl. 1):S12-S19.
Batista RJV, Verde J, Nery P, Bocchino L, Takeshita N, Bhayana JN, Bergsland J, Graham S, Houck JP, Salerno TA. Partial left ventriculectomy to treat endstage heart disease. Ann Thorac Surg 1997;64:634–638.
McCarthy JF, McCarthy PM, Starling RC, Smedira NG, Scalia GM, Wong J, Kasirajan V, Goormastic M, Young JB. Partial left ventriculectomy and mitral valve repair for end-stage congestive heart failure. Eur J Cardiothorac Surg 1998;13:337–343.
Bolling SF, Deeb GM, Brunsting LA, Bach DS. Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardiovasc Surg 1995;109(4):676–683.
Bolling SF, Pagani FD, Deeb GM, Bach SF. Intermediate-term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998;115:381–388.
Anguita M, Arizon JM, Bueno G, Latre JM, Sancho M, Torres F, Gimenez D, Concha M, Valles F. Clinical and hemodynamic predictors of survival in patients aged < 65 years with severe congestive heart failure secondary to ischemic or nonischemic dilated cardiomyopathy. Am J Cardiol 1993;72(5):413–417.
Dowling RD, Koenig SC, Ewert DL, Laureano MA, Gray LA. Acute cardiovascular changes of partial left ventriculectomy without mitral valve repair. Ann Thor Surg 1996;67:1470–1472.
Rosario LB, Stevenson LW, Solomon SD, Lee RT, Reimold SC. The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size. J Am Coll Cardiol 1998;32:1819–1824.
Fann JI, Ingels NB, Miller DC. Pathophysiology of mitral valve disease and operative indications. In: Edmunds LH, ed. Cardiac Surgery in the Adult. NY: McGrawHill, 1997:959–990.
Akasaka T, Yoshida K, Hozumi T, Takagi T, Kaji S, Kawamoto T, Ueda Y, Okada Y, Morioka S, Yoshikawa J. Restricted coronary flow reserve in patients with mitral regurgitation improves after mitral reconstructive surgery. J Am Coll Cardiol 1998;32:1923–1930.
Kawaguchi HK, Kitabatake A. Alterations of signal transduction system in heart failure. Japan Heart J 1997;38:317–332.
Bohm M. Catecholamine refractoriness and their mechanisms in cardiocirculatory shock and chronic heart failure. J Thorac Cardiovasc Surg 1998;46(suppl):270–276.
Bristow MR, Ginsburg R, Minobe W, Cubicciotti RS, Sageman WS, Lurie K, Billingham ME, Harrison DE, Stinson EB. Decreased catecholamine sensitivity and beta-adrenergic receptor density in failing human hearts. N Engl J Med 1982;307:205–211.
Brodde OE. Beta 1-and Beta 2-adrenoceptors in the human heart: properties, function, and alterations in chronic heart failure. Pharmacol Rev 1991;43(2):203–242.
Harding SE, Brown LA, Wynne DG, Davies CH, Poole-Wilson PA. Mechanisms of β-adrenoceptor desensitization in the failing human heart. Cardiovasc Res 1994;28:1451–1460.
Torre-Amione G. The syndrome of heart failure: emerging concepts in the understanding of its pathogenesis and treatment. Current Opinion in Cardiology 1999;14:193–195.
Bohm M. Alterations of beta-adrenoceptor-G-protein-regulated adenylyl cyclase in heart failure. Mol Cell Biochem 1995;147(1–2):147–160.
Bohm M, Diet F, Kemkes B, Erdmann E. Enhancement of the effectiveness of milrinone to increase force of contraction by stimulation of cardiac beta-adrenoceptors in the failing human heart. Klinische Wochenschrift 1998;66(19):957–962.
Feldman MD, Copelas L, Gwathmey JK, Phillips P, Warren SE, Schoen FJ, Grossman W, Morgan JP. Deficient production of cyclic AMP: pharmacologic evidence of an important cause of contractile dysfunction in patients with end-stage heart failure. Circulation 1987;75(2):331–339.
Pagani FD, Baker LS, Hsi C, Knox M, Fink MP, Visner MS. Left ventricular systolic and diastolic dysfunction after infusion of tumor necrosis factor-α in conscious dogs. J Clin Invest 1992;90:389–398.
Blum A, Miller H. Role of cytokines in heart failure. Am Heart J 1988;135 (2 pt 1):181–186.
Torre-Amione G, Kapadia S, Benedict C, Oral H, Young JB, Mann DL. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the Studies of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 1996;27(5):1201–1206.
Levine B, Kalman J, Mayer L, Fillit HM, Packer M. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 1990;323:236–241.
Herrera-Garza EH, Stetson SJ, Cubillos-Garzon A, Vooletich MT, Farmer JA, Torre-Amione G. Tumor necrosis factor-α: A mediator of disease progression in the failing human heart. Chest 1999;115:1170–1174.
Suffredini AF, Fromm RE, Parker MM, Brenner M, Kovacs JA, Wesley RA, Parrillo JE. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 1989;321(26):1828–1830.
Hagewisch S, Weh HJ, Hossfeld DK. TNF-induced cardiomyopathy. Lancet 1990;335(8684):294–295.
Milani RV, Mehra MR, Endres S, Eigler A, Cooper ES, Lavie CJ, Ventura HO. The clinical relevance of circulating tumor necrosis factor-alpha in acute decompensated chronic heart failure without cachexia. Chest 1996;110(4):992–995.
Torre-Amione G, Kapadia S, Lee J, Durand JB, Bies R, Young JB, Mann DL. Tumor necrosis factor-alpha and tumor necrosis factor receptors in the failing human heart. Circulation 1996;93(4):704–711.
Ferrari R, Bachetti T, Confortini R, Opasich C, Febo O, Corti A, Cassani G, Visioli O. Tumor necrosis factor soluble receptors in patients with various degrees of congestive heart failure. Circulation 1995;92(6):1479–1486.
Van Zee KJ, Kohno T, Fischer E, Rock CS, Moldawer LL, Lowry SF. Tumor necrosis factor soluble receptors circulate during experimental and clinical inflammation and can protect against excessive tumor necrosis factor alpha in vitro. Proc Nat Acad Sci 1992;89(11):4845–4849.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bolling, S.F. Mitral Valve Reconstruction in the Patient with Heart Failure. Heart Fail Rev 6, 177–185 (2001). https://doi.org/10.1023/A:1011421014480
Issue Date:
DOI: https://doi.org/10.1023/A:1011421014480