Mitral valve repair surgery is much more technically demanding and may involve higher risk. Occasionally, the mitral valve is abnormal from birth (congenital). More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever. In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease) or non-ischemic heart disease (dilated cardiomyopathy). In 1923 Dr. Elliott Cutler of the Peter Bent Brigham Hospital performed the world’s first successful heart valve surgery – a mitral valve "repair". The patient was
Mitral insufficiency of the regurgitant flow at the level of the valve. This is known as the regurgitant orifice area, and correlates with the size of the defect in the mitral valve. One particular echocardiographic technique used to measure the orifice area is measurement of the proximal isovelocity surface area (PISA). The flaw of using PISA to determine the mitral valve regurgitant orifice area is that it measures the flow at one moment in time in the cardiac cycle, which may not reflect the average performance of the regurgitant jet. The treatment of mitral insufficiency depends on the acuteness of the disease