Mitral valve reconstruction in the patient with heart failure.

Secondary MR is a complication of end-stage cardiomyopathy and is associated with a poor prognosis and is due to progressive mitral annular dilation and alteration in LV geometry. A vicious cycle of continuing volume overload, ventricular dilation, progression of annular dilation, increased LV wall tension and worsening MR and CHF occur. The mainstay of medical therapy is diuretics and afterload reduction, and is associated with poor long-term survival in these patients with CHF and MR. However, surgical intervention in the form of undersized, 'overcorrecting' mitral valve repair has shown great promise and is an area of ongoing investigation.