Mitral annular dilatation plays an important pathophysiologic role in patients with both primary and secondary mitral regurgitation (MR). Traditional treatment with surgical mitral annuloplasty (SMA) serves to restore the size and shape of the mitral annulus, maintain long-term annular reduction and provide functional annular support. SMA is a well-established adjunctive tool, in addition to plication, resection, etc., for primary MR and improves the durability of the repair (1). The clinical benefit of SMA in the treatment of secondary MR is much less certain, continually debated and likely dependent on the pathology involved (i.e., ischemic versus non-ischemic) along with anatomic selection criteria (e.g., degree of tethering, leaflet angles, tenting area and inter-papillary muscle distance) (1).
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