Application of the LDL-density-pressure theory: The mitral valve

Abstract

Myxomatous mitral valve regurgitation is the most common indication for surgical valve repair in the world [1]. For years this disease was thought to be a passive degenerative phenomenon. Understanding of the cellular mechanisms of this valve lesion will present improved understanding of this disease and targeted therapy either surgical or medical. Diagnosing mitral regurgitation (MR) and timing to surgical correction is one of the most challenging in the clinical cardiology. Chronic MR, due to increasing prevalence of myxomatous disease and the increasing mean age of population, is presenting as often as aortic stenosis: moderate or severe MR is found in 1.7 % of the general population and in up to 9.3 % of those over 75 years [1]. Echocardiography is the main tool for MR evaluation. In the modern times of mitral valve (MV) repair surgery, echocardiography has become even more important because the study has to cover not only the MR diagnosis, but also the evaluation of the valvular lesions and the mechanisms of disease to guide the election between the different therapeutic options. This combination of aspects related to the complexity of mitral regurgitation is the primary driving force to develop an all encompassing assessment of MR to allow the clinician and surgeon to achieve the important clinical outcomes. One of the key aspects for the elusiveness of this disease, from the clinical perspective, is the understanding of how the mitral valve develops myxomatous changes.