Summary
Regardless of its etiology, FMR is provoked by progressive remodeling
and dysfunction of the left cardiac chambers. Accurate assessment of the
dynamic interactions among MV, its entire apparatus and left
ventricle/atrium is critically important to help define patient risk and
their response to tailored therapies.57,58 GDMT and
CRT, when indicated, remain the initial treatment strategy. The exact
role of surgical and transcatheter interventions in the treatment of FMR
will continue to be elucidated as the recognition of the critical
importance of LV geometry in determining valvular function and clinical
outcomes evolve. Recently proposed new conceptual framework of
proportionate and disproportionate MR help identify which patients
benefit from treatments that can decrease LV volumes and reverse LV
remodeling (e.g., neurohormonal antagonists) or from interventions that
are directed toward the restoration of normal MV function, such as CRT
or MV repair, particularly when appropriate annular and adjunct leaflet
or subvalvular reconstructions are utilized. Future well-designed RCTs
are needed to evaluate the real benefit of surgical or transcatheter
repair in FMR.