**Echocardiography in Valvular Heart Disease**

**1** 

*Italy* 

**The Degenerative Mitral Valve Regurgitation:** 

Echocardiography has become within the last years the main tool in the evaluation of the valvulopathies. Surgery plays a key role in the management of the valvular disorders, but it must be underlined that the surgical timing, planning and indication are all widely based on echocardiography. All the guidelines use the echocardiographic criteria to manage the valvular patients. Echocardiography became the main tool for the selection of the patient candidate to valve repair or replacement. The echocardiographic assessment is important in all the valvulopathies, but becomes crucial in the management of patients with mitral

Still, it should be noted, that there is no randomized study comparing the mitral valve repair and mitral valve replacement, and comparisons between the two, using propensity matching or other statistical methods are very difficult. On the other hand there are numerous studies which suggest that the short and long term outcomes of patients undergoing successful mitral valve repair are superior to those undergoing replacement.

Mitral valve repair has been proved to increase additional operative and long-term survival advantages over mitral valve replacement in case of chronic mitral regurgitation. The reduction in the left ventricular pump performance that has been observed after conventional mitral valve replacement, has not been obvious with mitral valve repair, provided that the postoperative contractile state remains pretty similar to the preoperative hemodynamic status. Compared to mitral replacement, mitral valve repair has lower mortality rates and higher long-term survival.. In addition, the thromboembolic and haemorrhagic complications associated with mitral valve reconstruction are also significantly decreased compared to mitral valve replacement. Several studies have reported that approximately 95% of patients are free from thromboembolic complications at 5 to 10 years after surgery. In contrast, 10% to 35% of patients with mechanical prostheses have thromboembolic events within 5 to 10 years after surgery (Bonow, 2011). Thus, the number of mitral valve repairs is expected to increase because the advantages over replacement

Nowadays, the number of patients undergoing mitral repair surgery is growing worldwide. The STS database proves that in the US, the percentage of patients undergoing mitral valve

**1. Introduction** 

insufficiency, candidate to mitral valve repair.

were also clearly demonstrated by daily practice.

**From Geometrical Echocardiographic** 

Gheorghe Cerin, Bogdan Adrian Popa and Marco Diena

*The Cardioteam Foundation / San Gaudenzio Clinic, Novara* 

**Concepts to Successful Surgical Repair** 
