0Ires a high repair rate and a low operative mortality; therefore currently not all patients and not all institutions are candidates to apply the early indications of surgical correction of mitral regurgitation. Nevertheless, considerable progresses have recently been accomplished for the assessment and treatment of mitral regurgitation and surgery should be considered early in the course of the disease, when severe regurgitation has been diagnosed. ​ table t1 aetiology and mechanism of mitral regurgitation table t2 timing of surgery in organic mitral regurgitation table t3 timing of surgery in ischaemic mitral regurgitation notes copyright 2002 mayo foundation references 1. Enriquez-sarano m, basmadjian a, rossi a, et al. Progression of mitral regurgitation: a prospective doppler echocardiographic study. J am coll cardiol 1999;34:1137–44. buy viagra online cheap [pubmed] 2. Enriquez-sarano m, tajik a, schaff h, et al. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J am coll cardiol 1994;24:1536–43. [pubmed] 3. Delahaye j, gare j, viguier e, et al. Natural history of severe mitral regurgitation. online sale viagra Eur heart j 1991;12(suppl b):5–9. 4. Horstkotte d, loogen f, kleikamp g, et al. Effect of prosthetic heart valve replacement on the natural course of isolated mitral and aortic as well as multivalvular diseases. Clinical results in 783 patients up to 8 years following implantation of the björk-shiley tilting disc prosthesis. Z kardiol 1983;72:494–503. [pubmed] 5. Ling h, enriquez-sarano m, seward j, et al. Clinical outcome of mitral regurgitation due to flail leaflets. N engl j med 1996;335:1417–23. A study of 229 patients with mitral regurgitation caused by flail leaflets. The study shows excess mortality under conservative management with high morbidity and 90% of patients with either death or surgery 10 years after diagnosis. [pubmed] 6. Grigioni f, enriquez-sarano m, ling l, et al. cheap online viagra Sudden death in mitral regurgitation due to flail leaflet. J am coll cardiol 1999;34:2078–85. A study of sudden death in 348 patients with mitral regurgitation showing that sudden death occurs at a rate of 1. 8% per year overall. buy viagra without prescription The predictors of sudden death are ejection fraction, symptoms, and atrial fibrillation. In patients with no risk factors the rate of sudden death was 0. 8% per year. [pubmed] 7. Enriquez-sarano m, tajik a, schaff h, et al. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation 1994;90:830–7. A large study of the outcome of mitral surgery for mitral regurgitation, analysed as a function of preoperative left ventricular function. Despite its limitation, ejection fraction was the best predictor of long term survival. [pubmed] 8. order viagra without prescription Crawford m, souchek j, oprian c, et al. Determinants of survival and left ventricular performance after mitral valve replacement. buy cheap generic viagra online Circulation 1990;81:1173–81. [pubmed] 9. Enriquez-sarano m, schaff h, orszulak t, et al. Congestive heart failure after surgical correction of mitral regurgitation. A long-term study. Circulation 1995;92:2496–503. [pubmed] 10. Bonow r, carabello b, deleon a, et al. Acc/aha guidelines for the management of patients with valvular heart disease. Circulation 1998;98:1949–84. A large summary of the literature on valvar heart disease and the recommendations made by the panel on that basis for surgery. [pubmed] 11. Leung d, griffin b, stewart w, et al. Left ventricular function after valve repair for chronic mitral regurgitation: predictive value of preoperative assessment of contractile reserve by exercise echocardiography. J am coll cardiol 1996;28:1198–205. [pubmed] 12. buy cheap generic viagra online Kishon y, oh j, schaff h, et al. Mitral valve operation in postinfarction rupture of a papillary muscle: immediate results and long term follow up of 22 patients. Mayo clin proc 1992;67:1023–30. [pubmed] 13. Yiu s, enriquez-sarano m, tribouilloy c, et al. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study. Circulation 2000;102:1400–6. sales viagra [pubmed] 14. Lamas g, mitchell g, flaker g, et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Circulation 1997;96:827–33. A study reporting a subset (angiographic) of the save (survival and ventricular enlargement) study. Although severe mitral regurgitation was an exclusion of the save trial, the presence of mitral regurgitation in these patients included early after myocardial infarction was associated with poor survival independently of all other baseline characteristics. [pubmed] 15. buy cheap generic viagra online Grigioni f, enriquez-sarano m, zehr k, et al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative doppler assessment. Circulation 2001;103:1759–64. A study of chronic ischaemic (post-myocardial infarction) heart disease with and without mitral regurgitation. The mitral regurgitation was quantified by doppler echocardiography. The patients with mitral regurgitation had a pronounced excess mortality and the ero was the best predictor of survival. generic low price viagra [pubmed] 16. Desjardins v, enriquez-sarano m, tajik a, et al. Intensity of murmurs correlates with severity of valvular regurgitation. Am j med 1996;100:149–56. [pubmed] 17. viagra jelly Cohn l, couper g, kinchla n, et al. Decreased operative risk of surgical treatment of mitral regurgitation with or without coronary artery disease. J am coll cardiol 1990;16:1575–8. [pubmed] 18. Tribouilloy c, enriquez-sarano m, schaff h, et al. Impact of preoper. buy cheap generic viagra online 123456

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