Abdallah El Sabbagh, Yogesh N.V. Reddy, Rick A. Nishimura

Mitral valve regurgitation (MR) is the most common valvular heart disease. Primary MR is a disease of the mitral valve apparatus, whereas secondary MR is a disease of the left ventricle. Diagnosing and managing MR is often challenging and requires a structured approach, integrating findings on history, physical examination, and imaging. Decisions regarding treatment depend on knowledge of the etiology, natural history, and outcome of interventions for these patients with mitral valve disease. The optimal timing of intervention requires a comprehensive 2-dimensional and Doppler echocardiogram in each patient to determine the cause of the mitral valve disease, the severity of the regurgitation, and the effect of the volume overload on the left ventricle, as well as determining if a durable valve repair can be performed. Advances in both surgical and catheter-based therapies have resulted in recommendations for lower thresholds for operation and extension of interventional treatments to the older, sicker population of patients with MR. The current review discusses the pathophysiological rationale for current diagnostic and management strategies in MR.