A.I. Burnasyan Scientific journal FMBC

Clinical Bulletin

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №2 2022 год

A.I. Burnasyan  FMBC clinical bulletin. 2022 № 1

Mitral Regurgitation and Floppy Mitral Valve in the Internist’s Practice
Posokhov I.N.
A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia

Contact person: Igor Posokhov, igor@posohov.ru
The focus of this lecture is on classical statements on primary and secondary mitral regurgitation combined with a review of recent literature. The most common cause of mitral regurgitation are floppy mitral valve, its prolapse with and without ruptured chords, rheumatic heart disease, infective endocarditis, hypertrophic and dilated cardiomyopathy, coronary artery disease. Mitral valve prolapse can occur without regurgitation, but still have a clinical significance. In the practice of non-surgical specialists, this causes both common and different aspects of managing patients with mitral regurgitation of various etiologies and floppy mitral valve.

Keywords: mitral regurgitation, floppy mitral valve
For citation: Posokhov IN. Mitral Regurgitation and Floppy Mitral Valve in the Internist’s Practice. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2022.1:45–56. (In Russian) DOI: 10.33266/2782-6430-2022-1-45-56

1. Otto C., Bonow R. Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. Elsevier, 2020. 608 p.

2. Otto C.M., Nishimura R.A., Bonow R.O., et al., 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143;5:e72-e227.
3. Vahanian A., Beyersdorf F., Praz F., et al. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Eur. Heart J. 2021;43;7:561-632.
4. Althunayyan A., Petersen S.E., Lloyd G., Bhattacharyya S. Mitral Valve Prolapse. Expert Rev Cardiovasc Ther. 2019;17;1:43-51.
5. Boudoulas K.D., Pitsis A.A., Mazzaferri E.L., Gumina R.J., Triposkiadis F., Boudoulas H. Floppy Mitral Valve/Mitral Valve Prolapse: A Complex Entity with Multiple Genotypes and Phenotypes. Prog. Cardiovasc Dis. 2020;63;3:308-326.
6. Bonow R.O., O’Gara P.T., Adams D.H., et al. 2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;75;17:2236-2270.
7. Levine R.A., Hagege A.A., Judge D.P., et al. Mitral Valve Disease: Morphology and Mechanisms. Nat. Rev. Cardiol 2015;12:689-710.
8. Carpentier A. Cardiac Valve Surgery–the “French Correction”. J. Thorac Cardiovasc Surg. 1983;86;3:323-337.
9. Dejgaard L.A., Skjølsvik E.T., Lie Ø.H., et al. The Mitral Annulus Disjunction Arrhythmic Syndrome. J. Am. Coll. Cardiol. 2018;72;14:1600-1609.
10. Adams D.H., Rosenhek R., Falk V. Degenerative Mitral Valve Regurgitation: Best Practice Revolution. Eur. Heart J. 2010;31;16:1958-1966.
11. Theofilogiannakos E.K., Boudoulas K.D., Gawronski B.E., et al. Floppy Mitral Valve/Mitral Valve Prolapse Syndrome: Beta-Adrenergic Receptor Polymorphism May Contribute to the Pathogenesis of Symptoms. J. Cardiol. 2015;65:434–438.
12. Okada Y., Nakai T., Kitai T. Role of Mitral Valve Repair for Mitral Infective Endocarditis. Cardiol Clin. 2021;39;2:189-196.
13. Tomasell G.F., Braunwald E., Libby P. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier. 2021, 234 p.
14. Otto C.M., Prendergast B. Aortic-Valve Stenosis – from Patients at Risk to Severe Valve Obstruction. N. Engl. J. Med. 2014;371;8:744-756.
15. Damluji A.A., van Diepen S., Katz J.N., et al. Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation. 2021;144;2:e16-e35.
16. Wolff R., Cohen G., Peterson C., et al. MitraClip for Papillary Muscle Rupture in Patient with Cardiogenic Shock. Can. J. Cardiol. 2014;30;1461:e13–e14.
17. Vinciguerra M., Romiti S., Wretschko E., D’Abramo M., Rose D., Miraldi F., Greco E. Mitral Plasticity: The Way to Prevent the Burden of Ischemic Mitral Regurgitation? Front. Cardiovasc Med. 2022;8:794574.
18. Tumenas A., Tamkeviciute L., Arzanauskiene R., Arzanauskaite M. Multimodality Imaging of the Mitral Valve: Morphology, Function, and Disease. Curr. Probl. Diagn Radiol. 2021;50;6:905-924.
19. Minder C.M., Whisenant B.K. Severe Mitral Regurgitation: Does One Size Fit all? Heart. 2020;106;12:872-873.
20. Calafiore A.M., Totaro A., Testa N., et al. The Secret Life of the Mitral Valve. J. Card. Surg. 2021;36;1:247-259.
21. Badiani S., van Zalen J., Althunayyan A, et al. Natriuretic Peptide Release During Exercise in Patients with Valvular Heart Disease: A Systematic Review. Int. J. Clin. Pract. 2021;75;10:e14137.
22. Basso C., Iliceto S., Thiene G., Perazzolo Marra M. Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death. Circulation. 2019;140;11:952-964.
23. Wibawa K., Ivan I., Jessica G., Ridjab D. The Outcome of Ventricular Arrhythmias Associated with Mitral Valve Prolapse After Catheter Ablation: A Systematic Review and Meta-Analysis. Cureus. 2021;13;12:e20310.
24. Miller M.A., Dukkipati S.R., Turagam M., Liao S.L., Adams D.H., Reddy V.Y. Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week. J. Am. Coll Cardiol. 2018;72;23 Pt A:2904-2914.
25. Slavich M., Palmisano A., Pannone L., Agricola E., Margonato A., Esposito A. Hidden Danger Behind the Prolapse. Circ. Cardiovasc Imaging. 2019;12;10:e009639.
26. Delling F.N., Rong J., Larson M.G., et al. Evolution of Mitral Valve Prolapse: Insights from the Framingham Heart Study. Circulation. 2016;133:1688–1695.
27. Mitral Regurgitation. Clinical Guidelines. Ministry of Health of the Russian Federation. 2016. URL: https://racvs.ru/clinic/files/2016/mitral-regurg.pdf (In Russ.). [Митральная регургитация: Клинические рекомендации. Министерствo Здравоохранения Российской Федерации. 2016 г. Интернет-ресурс. URL: https://racvs.ru/clinic/files/2016/mitral-regurg.pdf].
28. Pu M. The Frequency, Impact, and Management of Mitral Regurgitation in Patients with Heart Failure. Curr. Cardiol Rep. 2006;8;3:226-231.
29. Pavon A.G., Monney P., Schwitter J. Mitral Valve Prolapse, Arrhythmias, and Sudden Cardiac Death: The Role of Multimodality Imaging to Detect High-Risk Features. Diagnostics (Basel). 2021;11;4:683.
30. Pastore M.C., Mandoli G.E., Dokollari A., Bisleri G., D’Ascenzi F., Santoro C., Miglioranza M.H., Focardi M., Cavigli L., Patti G., Valente S., Mondillo S., Cameli M. Speckle Tracking Echocardiography in Primary Mitral Regurgitation: Should we Reconsider the Time for Intervention? Heart Fail Rev. 2021. Epub Ahead of Print.
31. Harris K.M., Aeppli D.M., Carey C.F. Effects of Angiotensin-Converting Enzyme Inhibition on Mitral Regurgitation Severity, Left Ventricular Size, and Functional Capacity. Am. Heart J. 2005;150:1106.
32. Ahmed M.I., Aban I., Lloyd S.G., et al. Arandomized Controlled Phase IIb Trial of Beta 1 Receptor Blockade for Chronic Degenerative Mitral Regurgitation. J. Am. Coll. Cardiol 2012;60:833-838.
33. Abbadi D.R., Purbey R., Poornima I.G. Mitral Valve Repair is an Effective Treatment for Ventricular Arrhythmias in Mitral Valve Prolapse Syndrome. Int. J. Cardiol. 2014;177:e16–e18. doi: 10.1016/j.ijcard.2014.07.174.
34. Vaidya V.R., DeSimone C.V., Damle N., Naksuk N., Syed F.F., Ackerman M.J., Ponamgi S.P., Nkomo V.T., Suri R.M., Noseworthy P.A., et al. Reduction in Malignant Ventricular Arrhythmia and Appropriate Shocks Following Surgical Correction of Bileaflet Mitral Valve Prolapse. J. Interv Card. Electrophysiol. 2016;46:137–143.

Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.01.2022.  Accepted for publication: 01.02.2022 


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