Publication

Abstract : MITRAL REGURGITATION (MR) presents as a consequence of a primary pathology of the mitral valve apparatus or secondary to ventricular dysfunction and remodeling. Most common etiology for primary MR is degenerative, with a prevalence of 1%-to-2%. 1 Degenerative mitral valve disease is a progressive, noninflammatory, structural distortion of the valve apparatus, culminating in leaflet prolapse and regurgitation. Some of these patients present acutely due to rupture of the abnormal chordae, whereas most others present with chronic progressive MR. The spectrum of this disease is wide, ranging from fibroelastic degeneration, through forme-fruste, to Barlow's. Pathogenesis of mitral valve prolapse (MVP) has been shifting from a degenerative process involving the leaflets to an intrinsic annular abnormality. The subset in which this abnormal annular anatomy and kinetics have been demonstrated is now categorized as mitral annular disjunction (MAD). Although, primarily, MVP is characterized by leaflet and chordal involvement with secondary changes in the annulus, MAD is found to have a primary annular involvement with secondary changes in leaflets and myocardium. Typically, MAD presents as a discontinuation of the annuloatrial junction from the ventricular myocardium. It is more commonly associated with myxomatous MVP than the fibroelastic variant. 2 Similar to MVP, it has a female preponderance. 3 It still is unclear whether it is MAD or MVP that is the initiating trigger for MR.