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Mitral Valve Prolapse and Mitral Regurgitation
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Mitral Valve Prolapse and Mitral Regurgitation

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (31 August 2022) | Viewed by 11167

Special Issue Editors

Dr. Laura Fusini

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Guest Editor
Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
Interests: cardiac imaging; mitral valve; prolapse; mitral regurgitation; aortic stenosis; valve prosthesis; left and right ventricular function
Dr. Matteo Cameli

E-Mail Website
Guest Editor
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
Interests: heart failure; atrial fibrillation; echocardiography; hypertension; heart; cardiology; transesophageal echocardiography; cardiovascular system; cardiac function; electrocardiographyh
Special Issues, Collections and Topics in MDPI journals
Dr. Francesca Baessato

E-Mail Website
Guest Editor
Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy
Interests: cardiovascular magnetic resonance; echocardiography; valvular disease; myocardial disease; cardiac surgery

Special Issue Information

Dear Colleagues,

Mitral valve prolapse (MVP) is a common valvular disease afflicting 1–3% of the general population and represents the most frequent cause of primary mitral regurgitation (MR). Structurally, mitral valve leaflets are typically elongated and redundant, with myxomatous degeneration. In the last few years, structural abnormalities such as “mitral annular disjunction” have been reported, especially in high-risk patients with life-threatening arrhythmias. Calcific degeneration of the mitral annulus may also be described, eventually leading to concomitant mitral stenosis.

Non-invasive imaging tests are fundamental tools that allow both morphologic and functional insights into MVP and MR, patients’ risk profile and burden of disease. Two-dimensional (2D) echocardiography represents a milestone for the imaging of MVP and the assessment of MR severity and progression. In particular, transthoracic echocardiography is considered the first-line modality for diagnosis and follow-up of patients, while transesophageal echocardiography especially valuable for planning surgical or percutaneous interventions. The addition of real-time 3-dimensional (3D) data has allowed more detailed definition of anatomical leaflet alterations and annular geometry, integrated with quantification analysis of displacement. Besides echocardiography, cardiovascular magnetic resonance (CMR) has gained great importance because it has the highest accuracy in the quantification of MR and volume overload and function of the left ventricle, while also having strong prognostic power. It has been demonstrated that MVP could be associated with structural alterations and fibrosis of the papillary muscles and of the left ventricular myocardium, especially in the basal inferolateral wall, which represents a substrate for arrhythmic events.

Quantification of MR through either 2D and 3D echocardiography or CMR is central in patient management and, when integrated with clinical data, defines the need for intervention. When indicated, standard of care is surgical mitral valve repair. However, transcatheter procedures have recently been incrementally performed in patients with high surgical risk, showing good outcomes at follow-up. Moreover, newer percutaneous techniques involving annuloplasty, chordae replacement and mitral valve repair may revolutionize the non-surgical pathway of patient treatment in the near future.

This Special Issue is not limited to the diagnosis, management and treatment of MVP and MR. We kindly invite you to consider contributing a research paper or review article on any aspect related to the topic of this Special Issue. This may also be an opportunity for surgeons, cardiologists, cardiac imagers, clinical fellows, and doctoral and post-doctoral trainees to contribute a review article and showcase their area of expertise.

Dr. Laura Fusini
Dr. Matteo Cameli
Dr. Francesca Baessato
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mitral valve prolapse
  • mitral regurgitation
  • mitral valve disease
  • echocardiography
  • non-invasive imaging

Published Papers (3 papers)

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Research

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13 pages, 1548 KiB  
Article
Left Atrial Remodeling after Mitral Valve Repair for Primary Mitral Regurgitation: Evolution over Time and Prognostic Significance
by Jan Stassen, Aniek L. van Wijngaarden, Hoi W. Wu, Meindert Palmen, Anton Tomsic, Victoria Delgado, Jeroen J. Bax and Nina Ajmone Marsan
J. Cardiovasc. Dev. Dis. 2022, 9(7), 230; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9070230 - 18 Jul 2022
Cited by 3 | Viewed by 2360
Abstract
Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir [...] Read more.
Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir strain (LASr) were evaluated immediately before and after surgery, and during long-term follow-up in 226 patients undergoing mitral valve repair for primary MR (age 62 ± 13 years, 66% male). Mean LAVi was reduced significantly after surgery and at long-term follow-up (from 56 ± 28 to 38 ± 21 to 32 ± 17 mL/m2; p < 0.001). LASr reduced significantly after surgery but increased again during the long-term (from 23.6 ± 9.4 to 11.5 ± 5.0 to 17.3 ± 7.5%; p < 0.001). Age, pre-operative LAVi, MR severity, and postoperative transmitral pressure gradient were associated with LA reverse remodeling by the long-term check-up. During a median follow-up of 72 (40–114) months, 43 (19%) patients died. Patients with LAVi ≥ 42 mL/m2 at long-term follow-up showed significant higher mortality rates compared to patients with LAVI < 42 mL/m2 (p < 0.001), even after adjusting for clinical covariates. In conclusion, significant LA reverse remodeling was observed both immediately and at long-term follow-up after mitral valve repair. LA dilatation at long term follow-up after surgery was still associated with all-cause mortality. Full article
(This article belongs to the Special Issue Mitral Valve Prolapse and Mitral Regurgitation)
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Review

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12 pages, 2596 KiB  
Review
Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce?
by Francesca Baessato, Laura Fusini, Manuela Muratori, Gloria Tamborini, Sarah Ghulam Ali, Valentina Mantegazza, Andrea Baggiano, Saima Mushtaq, Mauro Pepi, Giuseppe Patti and Gianluca Pontone
J. Cardiovasc. Dev. Dis. 2023, 10(4), 150; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10040150 - 31 Mar 2023
Cited by 1 | Viewed by 2356
Abstract
Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and [...] Read more.
Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality. Full article
(This article belongs to the Special Issue Mitral Valve Prolapse and Mitral Regurgitation)
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15 pages, 3835 KiB  
Review
Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management
by Apurba K. Chakrabarti, Frank Bogun and Jackson J. Liang
J. Cardiovasc. Dev. Dis. 2022, 9(2), 61; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9020061 - 16 Feb 2022
Cited by 11 | Viewed by 5798
Abstract
Mitral valve prolapse (MVP) is a common cause of valvular heart disease. Although many patients with MVP have a benign course, there is increasing recognition of an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death (SCD). Pathophysiologic mechanisms associated with arrhythmias [...] Read more.
Mitral valve prolapse (MVP) is a common cause of valvular heart disease. Although many patients with MVP have a benign course, there is increasing recognition of an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death (SCD). Pathophysiologic mechanisms associated with arrhythmias include cardiac fibrosis, mechanical stress induced changes in ventricular refractory periods, as well as electrophysiologic changes in Purkinje fibers. Clinically, a variety of risk factors including demographic, electrocardiographic, and imaging characteristics help to identify patients with MVP at the highest at risk of SCD and arrhythmias. Once identified, recent advances in treatment including device therapy, catheter ablation, and surgical interventions show promising outcomes. In this review, we will summarize the incidence of ventricular arrhythmias and SCD in patients with MVP, the association with mitral annular disjunction, mechanisms of arrhythmogenesis, methods for arrhythmic and SCD risk stratification including findings with multimodality imaging, and treatments for the primary and secondary prevention of SCD. Full article
(This article belongs to the Special Issue Mitral Valve Prolapse and Mitral Regurgitation)
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