Clinical Implications
The concept that secondary leaflet tethering is a significant mechanism
behind severe degenerative mitral regurgitation has several clinical
consequences. First of all, our study corroborated a pathophysiologic
rationale for early surgical repair. Secondly, emphasis may be given to
leaflet tethering quantification for MVP patients during the routine
echocardiographic evaluation as to assist in MR severity grading and
risk stratification. Finally, MV repair for PML prolapse is an
established procedure[1], whereas studies
regarding MV repair for MVPt+ patients are sparse. Otani et al.
demonstrated that MV repair for MVPt+ patients alleviate leaflet
tethering and even restore it to normal range, reflecting a favorable
surgical result. [8] Sakaguchi et al. reported
leaflet tethering in MVP could pose challenge to surgical repair as a
risk factor for MR occurrence.[9] As the above
studies were limited with small sample size, whether secondary leaflet
tethering in MVP impacts the result of MV repair or whether it could be
a complementary therapeutic target should be further investigated in a
larger patient group.