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Valve Surgery in Patients with Left Ventricular Dysfunction

As discussed in  Chap. 66, the surgical treatment of valvular heart disease that leads to LV dysfunction or heart failure is now widely accepted. However, patients who have valvular dysfunction secondary to a primary cardiomyopathy pose a much more difficult management problem. The following section focuses on the impact and outcome of valve repair or replacement for patients with a dilated cardiomyopathy and secondary mitral regurgitation. The indications for valve replacement in ischemic mitral regurgitation are discussed in  Chap. 66.

Mitral Valve

Mitral regurgitation (MR) is commonly observed in patients with heart failure and associated with a poor prognosis.[18] Progressive LV remodeling characterized by progressive LV dilation and a change to a more spherical shape can result in functional MR as a result of annular dilation, papillary muscle displacement, and chordal tethering (see  Chap. 66). The functional MR leads to an …