Functional Regurgitation of Atrioventricular Valves and Atrial Fibrillation: An Elusive Pathophysiological Link Deserving Further Attention

In patients with structurally normal atrioventricular valvular apparatus, functional regurgitation of the mitral or tricuspid valves has been attributed mainly to ventricular dilation and/or dysfunction, through a combination of annulus dilation and tethering of the valve leaflets. The occurrence of...

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Veröffentlicht in:Journal of the American Society of Echocardiography 2020-01, Vol.33 (1), p.42-53
Hauptverfasser: Muraru, Denisa, Guta, Andrada-Camelia, Ochoa-Jimenez, Roberto Carlos, Bartos, Daniela, Aruta, Patrizia, Mihaila, Sorina, Popescu, Bogdan A., Iliceto, Sabino, Basso, Cristina, Badano, Luigi Paolo
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container_issue 1
container_start_page 42
container_title Journal of the American Society of Echocardiography
container_volume 33
creator Muraru, Denisa
Guta, Andrada-Camelia
Ochoa-Jimenez, Roberto Carlos
Bartos, Daniela
Aruta, Patrizia
Mihaila, Sorina
Popescu, Bogdan A.
Iliceto, Sabino
Basso, Cristina
Badano, Luigi Paolo
description In patients with structurally normal atrioventricular valvular apparatus, functional regurgitation of the mitral or tricuspid valves has been attributed mainly to ventricular dilation and/or dysfunction, through a combination of annulus dilation and tethering of the valve leaflets. The occurrence of functional regurgitation of atrioventricular valves in patients with long-standing persistent atrial fibrillation and atrial dilation but normal ventricular size and function has received much less attention, and its peculiar mechanisms still remain to be understood. This distinct form of functional regurgitation (i.e., “atrial functional regurgitation”) may require different treatment and interventional repair approaches than the classical functional regurgitation due to ventricular dilatation and dysfunction (“ventricular functional regurgitation”), and current guideline recommendations do not yet address this distinction. Clarifying the differences in the pathophysiology of atrial functional regurgitation and its management implications is of paramount importance. This review describes briefly the comparative anatomy of mitral and tricuspid apparatus and the pathophysiology and typical echocardiographic features of atrial functional regurgitation compared with ventricular functional regurgitation, as well as the added value of three-dimensional echocardiography as an essential imaging tool to clarify the mechanisms involved in its development. [Display omitted] •Atrial fibrillation is associated with functional tricuspid and/or mitral regurgitation.•Dilatation of the annulus is the key mechanism of functional regurgitation.•3DE is key for assessing mechanisms of atriogenic functional regurgitation.•Understanding this entity may have important implications for its treatment.
doi_str_mv 10.1016/j.echo.2019.08.016
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subjects Atrial fibrillation
Atrial functional regurgitation
Atriogenic regurgitation
Mitral valve
Tricuspid valve
title Functional Regurgitation of Atrioventricular Valves and Atrial Fibrillation: An Elusive Pathophysiological Link Deserving Further Attention
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