Abstract

Primary mitral valve regurgitation is the second most frequent valve disease in the Western world. Definite treatment is surgical with few controlled studies to rely on. In general mild and mild/moderate regurgitation is well tolerated for years, but severe regurgitation often necessitates valve surgery. It is equally important to rule out severe mitral valve regurgitation, since unnecessary surgery can be avoided, but also rule in severe regurgitation because surgery too late often may be associated with an unfavourable outcome due to poor left ventricular function going unnoticed as a result of the mitral valve regurgitation related low impedance to left ventricular output [1-4]. In general, mitral valve regurgitation severity is determined by echocardiography, either transthoracic or transesophageal. Obviously it is important to understand the anatomical cause of regurgitation (only prolapse, or also flail cusp(-s)?) since prognosis is related to the underlying mechanism, but overall the pathophysiological more important parameter to determine is the mitral valve regurgitation volume, since it is this volume, and its relation to the left ventricular total stroke volume, that determines severity and impact on left ventricle preload.