Transcatheter mitral valve intervention in advanced heart failure


Edward Hospital Center for Advanced Heart Failure, Advocate Heart Institute


Unlike the taxonomy of cardiac valves based on location (pulmonary or aortic) or leaflet number (tricuspid), the mitral valve designation is an iconic one. Vesalius recognized the sheer complexity of this valve apparatus and chose to brand it after a bishop’s headgear, the mitre, owing to its likeness.1 Characteristically, the physiologic competence of the mitral valve is dependent on the competitive intersection of 5 distinct factors. These include an interplay among (1) left atrial size (and less importantly, function); (2) left ventricular dilation and contractile performance; (3) chordal tendons and papillary muscle alignment, integrity, and function; (4) mitral annular shape, size, and function; and finally (5) the anterior and posterior valvular leaflets and their scallops.2 A cardiomyopathic phenotype that leads to the clinical syndrome of advanced heart failure habitually produces distortion in all the elements necessary to cause mitral valvular incompetence without a direct pathology within the valve itself and is therefore referred to as secondary or functional mitral regurgitation

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