Treatment of Mitral Valve Prolapse with Severe Primary Mitral Regurgitation and NYHA Class III–IV Symptoms at High or Prohibitive Surgical Risk
This protocol addresses a defined high-risk subgroup: patients with mitral valve prolapse causing severe primary mitral regurgitation who remain severely symptomatic (NYHA functional class III or IV) despite management, and for whom conventional surgery carries high or prohibitive risk.
Clinical Scenario
Severe primary mitral regurgitation · NYHA class III or IV symptoms · High or prohibitive surgical risk · Favorable mitral valve anatomy for repair · Life expectancy at least 1 year
Approach (partial — full regimen behind the link)
A transcatheter repair technique applied directly to the mitral valve — transcatheter edge-to-edge repair (TEER) — is the intervention indicated for this scenario, when the anatomy is suitable.
Patient selection criteria, procedural details, and the full management algorithm are in the complete protocol.
Clinical Goal
Meaningful reduction in mitral regurgitation severity, targeting a 2–3 grade improvement.
References
In severely symptomatic patients (NYHA class III or IV) with primary severe MR and high or prohibitive surgical risk, transcatheter edge-to-edge repair (TEER) is reasonable if mitral valve anatomy is favorable for the repair procedure and patient life expectancy is at least 1 year.
Studies of TEER with a mitral valve clip have demonstrated improved symptoms and a reduction in MR by 2 to 3 grades, leading to reverse remodeling of the LV.
DOI: 10.1161/CIR.0000000000000923
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