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State of the Art in Mitral Valve Disease
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State of the Art in Mitral Valve Disease

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 3664

Special Issue Editor

Prof. Dr. Gilles D. Dreyfus

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Hôpital Européen Georges Pompidou, 75015 Paris, France
Interests: mitral valve repair techniques (resection vs no resection, long term results of mitral valve repair, robotic mitral repair, mitral and tricuspid repair, mitral repair failures why?)

Special Issue Information

Dear Colleagues,

Mitral valve disease is among the most prevalent valvular disorders, posing a significant challenge due to its high mortality and morbidity rates, especially as the global population ages. Recent advances in research and technology have shed new light on the mechanisms driving the disease, enabling earlier and more precise diagnosis, especially in our understanding of imaging and echocardiography, improved risk stratification, and optimized timing for interventions. Surgery remains the gold standard for treating primary mitral valve disease, and the debate is still going on with standard approaches as opposed to minimally invasive approaches, especially when dealing with long-term results. Percutaneous mitral valve repair and replacement are real noninvasive techniques and have demonstrated promising outcomes. Each treatment needs to be discussed with its pro and cons detailed.

This Special Issue will focus on the latest innovations in mitral valve disease management, from novel imaging modalities for early diagnosis to cutting-edge surgical and micro-invasive therapies. It will also highlight the evolving roles of cardiac anesthesiologists, intensivists, and cardiologists in perioperative care, which are increasingly important in achieving optimal patient outcomes. We invite full research submission "Articles" or comprehensive "Reviews" on these topics, offering a platform for forward-thinking approaches to mitral valve disease.

Prof. Dr. Gilles D. Dreyfus
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mitral valve pathophysiology and echocardiography
  • mitral valve stenosis
  • mitral valve regurgitation (primary, secondary, atrial ...)
  • standard vs minimally invasive mitral valve surgery
  • resection or no resection
  • TEER mitral valve “repair” or treatment
  • TEER mitral valve replacement: which prosthesis for which patient?
  • mitral valve replacement
  • mitral valve repair failures: why?
  • the future of mitral valve regurgitation

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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13 pages, 3619 KB  
Article
Topography of the Papillary Muscles in the Mitral Valve Complex and Their Relevance for Mitral Valve Function
by Alina-Jutta Van Laethem, Jens Figiel, Andreas H. Mahnken, Rabia Ramzan, Marc Irqsusi, Sebastian Vogt and Ardawan J. Rastan
J. Cardiovasc. Dev. Dis. 2025, 12(9), 348; https://doi.org/10.3390/jcdd12090348 - 11 Sep 2025
Viewed by 358
Abstract
Background: The mitral valve apparatus is a complex system that requires sufficient function of all involved structures. Previous studies have demonstrated that ventricular remodeling can cause displacement of subannular structures, including the papillary muscles, which in turn promotes the development of mitral regurgitation. [...] Read more.
Background: The mitral valve apparatus is a complex system that requires sufficient function of all involved structures. Previous studies have demonstrated that ventricular remodeling can cause displacement of subannular structures, including the papillary muscles, which in turn promotes the development of mitral regurgitation. Furthermore, in such cases, annuloplasty alone is often insufficient to restore optimal valve function. Instead, additional reconstruction of the subannular apparatus is associated with improved clinical outcomes. Our study aimed to analyze the topography of the papillary muscles in the mitral valve complex and their relevance for mitral valve function. Methods: In 148 patients who underwent both cardiac computed tomography (CT) and echocardiography, the position of the papillary muscles within the left ventricle was assessed. CT scans were evaluated in end-diastolic four-chamber view, two-chamber view, and short-axis view. CT analysis involved determining the position of the papillary muscles based on a modified left ventricular segmentation scheme, which subdivided the original segments into “a” and “b” subsegments in a counterclockwise manner. Furthermore, the midventricular diameter, ventricular length, as well as the angle between the papillary muscle (PM) and the left ventricular wall, were measured. Comorbidities were assessed. The presence of mitral regurgitation (MR) and ejection fraction was determined based on echocardiographic data. Echocardiography was conducted either as part of initial cardiological assessments or during follow-up examinations. For detailed statistical analysis, the patients were divided into the following groups: control group, MR-only group, coronary heart disease (CHD)-only group, and combined CHD and MR subgroup. Results: Mitral regurgitation was significantly correlated with age (p < 0.001) and hypertension (r = 0.1900, p = 0.0208), and in the MR-only subgroup, additionally with atrial fibrillation (r = 0.2426, p = 0.0462). The length (p < 0.001) and internal diameter (p < 0.001) of the left ventricle were significantly larger in men than in women. Different positions of the papillary muscles were identified. Segment 7a was significantly correlated with MR in the combined CHD and MR subgroup. In normal-sized ventricles, patients with MR and papillary muscle in 12a (p = 0.0095) or 10a (p = 0.0460) showed a significantly larger angle than patients without MR (overall dataset). Conclusions: Assessment of papillary muscle position is essential in diagnosing mitral regurgitation and should guide the consideration of subannular repair during surgical treatment. Full article
(This article belongs to the Special Issue State of the Art in Mitral Valve Disease)
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Review

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14 pages, 1157 KB  
Review
Mitral Annular Disjunction: Epidemiology, Diagnostic Methods, Prognosis, and Novel Implications
by Vasileios Tsimpiris, Georgia Kousourna, Aristi Boulmpou, Magdalini Petridou, Chalil Tsavousoglou, Dimitrios Kotzadamis, Christodoulos Papadopoulos, Dimitrios Ntelios, Theodoros Moysiadis, Vassilios Vassilikos and Efstathios Pagourelias
J. Cardiovasc. Dev. Dis. 2025, 12(8), 311; https://doi.org/10.3390/jcdd12080311 - 18 Aug 2025
Viewed by 783
Abstract
Mitral annular disjunction (MAD) is an increasingly recognized structural abnormality of the mitral valve apparatus, often associated with mitral valve prolapse and a heightened risk of ventricular arrhythmias and sudden cardiac death. It is defined by a separation between the mitral annulus and [...] Read more.
Mitral annular disjunction (MAD) is an increasingly recognized structural abnormality of the mitral valve apparatus, often associated with mitral valve prolapse and a heightened risk of ventricular arrhythmias and sudden cardiac death. It is defined by a separation between the mitral annulus and the left ventricular myocardium, best visualized during systole. In this review, we present an updated and comprehensive overview of MAD, drawing from recent large-scale imaging studies, expert consensus documents, and newly proposed classifications such as true versus pseudo-MAD. We discuss its prevalence, anatomical features, and diagnostic challenges across multiple imaging modalities, including transthoracic and transesophageal echocardiography, cardiovascular magnetic resonance, and computed tomography. We also explore its pathophysiological role in arrhythmogenesis, its prognostic implications, and current management strategies. Special attention is given to risk stratification based on imaging and cardiac rhythm findings, and we propose a practical clinical framework to guide decision-making. This review aims to support clinicians in recognizing MAD as a potentially arrhythmogenic condition that requires systematic evaluation and follow-up. Full article
(This article belongs to the Special Issue State of the Art in Mitral Valve Disease)
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16 pages, 2072 KB  
Review
Papillary Muscles of the Left Ventricle: Integrating Electrical and Mechanical Dynamics
by Csilla Andrea Eötvös, Teodora Avram, Roxana Daiana Lazar, Iulia Georgiana Zehan, Madalina Patricia Moldovan, Patricia Schiop-Tentea, Giorgia Coseriu, Adriana Sarb, Gabriel Gusetu, Elena Buzdugan, Roxana Chiorescu, Diana Mocan-Hognogi, Sorin Pop, E. Kevin Heist and Dan Blendea
J. Cardiovasc. Dev. Dis. 2025, 12(1), 14; https://doi.org/10.3390/jcdd12010014 - 31 Dec 2024
Cited by 1 | Viewed by 2047
Abstract
Background: Papillary muscles are structures integrated into the mitral valve apparatus, having both electrical and mechanical roles. The importance of the papillary muscles (PM) is mainly related to cardiac arrhythmias and mitral regurgitation. The aim of this review is to offer an overview [...] Read more.
Background: Papillary muscles are structures integrated into the mitral valve apparatus, having both electrical and mechanical roles. The importance of the papillary muscles (PM) is mainly related to cardiac arrhythmias and mitral regurgitation. The aim of this review is to offer an overview of the anatomy and physiology of the papillary muscles, along with their involvement in cardiovascular pathologies, including arrhythmia development in various conditions and their contribution to secondary mitral regurgitation. Methods: A literature search was performed on PubMed using the following relevant keywords: papillary muscles, mitral valve, arrhythmia, anatomy, and physiology. Results: During the cardiac cycle, papillary muscles have continuous dimensional and pressure changes. On one hand, their synchrony or dyssynchrony impacts the process of mitral valve opening and closure, and on the other hand, the pressure changes can trigger electrical instability. There is increased awareness of papillary muscles as an arrhythmic source. Arrhythmias arising from PM were found in patients with or without structural heart disease, via Purkinje fibres, due to increased automaticity or triggered activity. Conclusions: Despite the interest in mitral valve physiology, there are still many unknowns in relation to the papillary muscles, especially with regard to their role in arrhythmogenesis and the pathogenesis of mitral regurgitation. Full article
(This article belongs to the Special Issue State of the Art in Mitral Valve Disease)
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