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, 2000, Miller et al., 2007?and?Esmore et al., 2008). It was once thought that patients with LV dysfunction and MR would suffer if their Oxymatrine MV were made competent as they would lose the pop-off effect of MR (reversal of blood flow was somehow beneficial to LV function). The high mortality in earlier studies appears mainly related to loss of LV function by disruption of the sub-valvular apparatus because valve replacement (rather than repair) was mostly performed. The ��pop-off�� effect has been disproved and MV repair has been found not to add to surgical mortality (Bolling, 2002). MV repair (MVR), specifically mitral annuloplasty (MVA), has been proposed for selected patients with FMR due to systolic HF, although supportive data are limited to observational studies. Reduction of MR by MVA using partial or complete annuloplasty rings is accomplished by reducing the septal�Clateral diameter of the annulus, with resulting improved leaflet coaptation. Bolling and colleagues 1995 demonstrated that this approach was feasible and could be conducted with reasonably low morbidity. MVA using an undersized ring effectively corrects MR in HF patient and can safely be performed in patients even with the most compromised ventricles with an operative mortality of Tenofovir purchase reverse ventricular remodelling, improvement in NYHA functional class, and freedom from readmission for HF of 88%, 82%, and 72% at 1, 2, and 5?years, respectively, but the majority of the patients in this cohort have organic MR. These patients were also able to tolerate higher doses of medications after repair with 1, 2 and 5-year survival rates of 89%, 86% and 67%, respectively. MV surgery offered symptomatic improvement and survival benefit in patients with severe LVD and MR and more use of this surgery for FMR in DCM patients is warranted. Pomalidomide As surgeons gained more experience and expertise with MVR, the surgical mortality improved substantially and the use of MVR for patients with DCM has become a reasonable option (Calafiore et al., 2001). In selected patients, MV surgery, specifically MVA, in which the sub-valvular apparatus is left intact can lead to reduced ventricular size, improved LVEF and HF symptoms (Rothenburger et al., 2002?and?Carabello, 2004), and high-risk MV surgery may be an alternative to heart transplantation in some patients, however, this is not documented or supported by current practice guidelines.