Clinical Implications
The concept that secondary leaflet tethering is a significant mechanism behind severe degenerative mitral regurgitation has several clinical consequences. First of all, our study corroborated a pathophysiologic rationale for early surgical repair. Secondly, emphasis may be given to leaflet tethering quantification for MVP patients during the routine echocardiographic evaluation as to assist in MR severity grading and risk stratification. Finally, MV repair for PML prolapse is an established procedure[1], whereas studies regarding MV repair for MVPt+ patients are sparse. Otani et al. demonstrated that MV repair for MVPt+ patients alleviate leaflet tethering and even restore it to normal range, reflecting a favorable surgical result. [8] Sakaguchi et al. reported leaflet tethering in MVP could pose challenge to surgical repair as a risk factor for MR occurrence.[9] As the above studies were limited with small sample size, whether secondary leaflet tethering in MVP impacts the result of MV repair or whether it could be a complementary therapeutic target should be further investigated in a larger patient group.