Treatment of Symptomatic Severe Atrial Secondary Mitral Regurgitation with Preserved Left Ventricular Ejection Fraction
This protocol addresses a specific clinical scenario: symptomatic patients with severe atrial secondary mitral regurgitation (SMR) in whom left ventricular ejection fraction is preserved (≥50%), without regional wall motion abnormalities or leaflet tethering. Management in this population requires careful patient selection and a structured intervention strategy.
Clinical scenario
Preserved LVEF ≥50%
The defining features of this scenario are severe atrial SMR in a symptomatic patient with preserved left ventricular ejection fraction (≥50%), in the absence of regional wall motion abnormalities or leaflet tethering. Atrial secondary MR arises from atrial and annular remodelling rather than primary leaflet pathology, making this a distinct patient group requiring a tailored approach.
The defining features of this scenario are severe atrial SMR in a symptomatic patient with preserved left ventricular ejection fraction (≥50%), in the absence of regional wall motion abnormalities or leaflet tethering. Atrial secondary MR arises from atrial and annular remodelling rather than primary leaflet pathology, making this a distinct patient group requiring a tailored approach.
Management approach
The intervention strategy for this scenario centres on surgical options for eligible patients, with an alternative catheter-based intervention considered for those who are not suitable for surgery. The full structured protocol defines which approach applies, under what conditions, and with which co-interventions — details available via the link below.