Mitral valve disease: A view on pathophysiology and management of the
most common valve disease in the world
Abstract
Objectives: Mitral valve disease is increasingly prevalent. Timely
diagnosis and the choice of the right intervention are very important in
the early stages, as valvular dysfunction often leads to cardiac failure
and even sudden death. The focus of this paper is on the various
pathologies of the mitral valve, their etiology, and clinical
management. Methods: Mitral regurgitation (MR) can be managed
surgically, percutaneously or medically. Treatment methods for primary
MR include percutaneous mitral valve (MV) repair, MV replacement,
minimally invasive mitral valve surgery (MIMVS), and more recently,
robotics. Additionally, conventional sternotomy has been used for both
MR and mitral stenosis. Nonetheless, ongoing clinical trials are a clear
indicator that the management of valve diseases is continuously
evolving. Results: Multiple studies favour MV repair via MIMVS, over
conventional sternotomy or percutaneous approach. However, more data is
needed to optimize patient selection. Robot assisted repair is a new
alternative, but attention should be given to the steep learning curve
and medical training of professionals wishing to perform this
intervention. Cost effectiveness and possible side effects should be
explored by clinical trials as well. While guidelines are fairly
straightforward for primary MR, there is insufficient evidence to
suggest that surgical treatment is advantageous for secondary MR.
Management is usually pharmaceutical and aims to treat symptoms rather
than cause. Conclusion: Mitral valve disease remains a medical
challenge, but numerous research and clinical trials have been embarked
upon to refine old methods and discover new ones to improve treatment
success and procedural safety.