Management of mitral regurgitation due to mitral prolapse

Notable advances have been made in the treatment of mitral regurgitation, especially the advances resulting from prolapse of the mitral valve with or without a flail leaflet. Prosthetic mitral valve replacement results in a high incidence of postoperative left ventricular systolic dysfunction. Recognition of the importance of the subvalvular apparatus for preserving contractile function has fostered development of new repair techniques that preserve native valve tissue and reduce or eliminate postoperative systolic dysfunction and the need for anticoagulation. Vasoactive medications have a very limited role in the management of patients with primary mitral regurgitation. Better screening tools enable detection of early ventricular decompensation, and appropriate operative interventions continue to significantly reduce the morbidity and mortality associated with mitral regurgitation. Mortality associated with ischemic mitral regurgitation resulting from annular ring dilatation or structural damage associated with rupture of a papillary muscle continues to be high, and the simplest and most expeditious operative intervention is emphasized.