Dynamic secondary mitral regurgitation: squaring the circle

This editorial refers to ‘Prognostic impact of transcatheter mitral valve repair in patients with exercise-induced secondary mitral regurgitation’ by M.K. Izumo et al. pp. 530--8 The understanding and then the optimal treatment of secondary mitral regurgitation (MR), remains a totally unresolved challenge. ‘If you can’t explain it simply, you don’t understand it very well.’ Albert Einstein The results of COAPT and Mitra-Fr, and interpretations proposed since these two large randomized studies have not necessarily solved all the issues. Interesting concept of proportionate and disproportionate MR has been proposed, but it does not fit entirely with the patients that could be discussed among ‘cardiac-imagers’, surgeon, and interventionists during ‘heart team’ meetings.1–3 As a physician, our main goal is to improve patients’ symptoms and afterwards if possible, to improve their prognosis. Izumo et al.4 demonstrate a functional benefit, in selected patients treated for an exercise-induced secondary MR. Secondary MR results...