The short answer is no one can be sure. There are valid concerns that removing the MR off-load mechanism will lead to increased LVEDP as the underlying cardiomyopathy is still present. Right now, we have to approach each case individually. In my limited experience, MitraClip can and does help patients with cardiomyopathy and functional MR, and some patients improve from NYHA Class III-IV to Class I. Of course these are only isolated cases. One could assess for presence of myocardial reserve before proceeding with MitraClip.

I think that Mitral Regurgitation with low EF is a great challenge in cardiology. EF

Thanks Dr. Yeo,

I agree with you on the evidence that in the majority of patients remove the overload increases LVEDP, LV function and improves symptoms (NYHA class). However, in selected cases with EF particularly depressed I think it is also useful to assess the contractile reserve before percutaneous treatment of MR.

Dr. Jacob Thanks for your comment,

I agree with you that in patients with EF

In these cases, if you close or reduce de low pressure outflow (Mitral Regurgitation), rarely the Left Ventricle has contractile reserve to sustain the output against an unique high pressure outfow (Aorta). Clinical worse is the usual outcome.

If you have severe mitral regurgitation and reduce it to only moderate, the left ventricular EF will continue to decrease and the LV to enlarge. The only function of the mitralclip is augment the span of the spureus percutaneous treatment. There is no place to incomplete corrections. If the patient is a candidate, the patient should be considered to surgical treatment plus resinchronization if feasible.

Mitra clip may not be the answer in patients with low EF and severe MR.

Dear Albuin. Resinchronization is useful only if there is ventricular dyssinchronysm. I think that this is not the question.