**Author details**

Mechanical LV-assisted devices and heart transplantation should be considered in the most

Global LV remodeling EDD >65 mm, ESD >51 mm (ESV >140 mL) (low likelihood of reverse LV remodeling after

Complex jets originating centrally and posteromedially Posterolateral angle >45° (high posterior leaflet tethering)

Posterior papillary-fibrosa distance >40 mm

EDD, end-diastolic diameter; ESD, end-systolic diameter; ESV, end-systolic volume; LV, left ventricle.

Lateral wall motion abnormality

**Table 2.** Unfavorable TTE characteristics for mitral valve repair in secondary MR [88].

repair and poor long-term outcome) Systolic sphericity index >0.7

The controversies regarding an optimal surgical approach should be emphasized [87]. After surgical annuloplasty (undersized complete ring to restore leaflet coaptation), residual or recurrent functional MR is frequently observed (in approximately one-third of the cases) [88]. Valve-sparing mitral valve replacement techniques (leaving the leaflet and subvalvular apparatus intact to preserve the LV function) should be considered in patients with echocardiographic predictors of repair failure (**Table 2**) [88]. The surgery should also be considered in heart failure patients with severe functional MR and LVEF <30% but with an option for CABG and the evidence of myocardial viability. Qualification for surgical treatment of functional MR should be restrained if concomitant revascularization is not indicated [89]. Percutaneous edge-to-edge repair (MitraClip device) for FMR is a low-risk procedure and may be considered in patients during high surgical risk, whenever feasible [90]. The treatment may attenuate symptoms, improve quality of life and promote LV reverse remodeling but is inferior to surgical methods in terms of functional MR reduction. Valve intervention is generally contraindicated in patients with LVEF < 15% [13]. Two investigational extracardiac devices, CorCap (Acorn Cardiovascular) [91] and Coapsys (Myocor, Inc., Maple Grove, Minnesota) [92], which have been used to reshape the LV and thus to reduce the degree of functional MR, remained an interesting experiment. In cases of more advanced LV dysfunction (LVEF ≤ 30%) with no option for CABG, the Heart Team should choose between a palliative treatment of functional MR (surgical or transcatheter procedures, ventricular assist devices, heart transplantation) and a conservative therapy, after careful individual appraisal of the patient [13].

Irrespective of heart failure etiology, functional mitral regurgitation has a significant unfavorable impact on prognosis. The benefits of surgical treatment in functional mitral regurgitation

advanced stage of heart failure.

Mitral valve deformation Coaptation distance ≥1 cm

68 Structural Insufficiency Anomalies in Cardiac Valves

Tenting area > 2.5–3 cm<sup>2</sup>

Local LV remodeling Interpapillary muscle distance >20 mm

**7. Conclusion**

Barbara Brzezińska<sup>1</sup> \* and Krystyna Łoboz-Grudzień1,2

\*Address all correspondence to: be.brzezinska@gmail.com

1 Department of Cardiology, T. Marciniak Hospital, Wroclaw, Poland

2 Faculty of Health Science, Wroclaw Medical University, Poland
