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Mitral valve disease: A view on pathophysiology and management of the most common valve disease in the world
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  • Bianca Botezatu ,
  • Sahil Kakar,
  • MoLiu Ren,
  • Manasi Shirke,
  • Kellan Masharani ,
  • Kiran Pillai ,
  • Amer Harky
Bianca Botezatu
Queen's University Belfast Faculty of Medicine Health and Life Sciences
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Sahil Kakar
Queen's University Belfast Faculty of Medicine Health and Life Sciences
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MoLiu Ren
Queen's University Belfast Faculty of Medicine Health and Life Sciences
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Manasi Shirke
Queen's University Belfast Faculty of Medicine Health and Life Sciences
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Kellan Masharani
University of Liverpool
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Kiran Pillai
University of Liverpool
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Amer Harky
Liverpool Heart and Chest Hospital NHS Foundation Trust
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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.

Peer review status:UNDER REVIEW

06 Sep 2020Submitted to Journal of Cardiac Surgery
07 Sep 2020Assigned to Editor
07 Sep 2020Submission Checks Completed
11 Sep 2020Reviewer(s) Assigned