Heart, Lung and Circulation

Mitral Valve Regurgitation After Lung Transplantation: Aetiology, Management and Outcome

Published:November 24, 2021DOI:


      Problematic mitral regurgitation (MR) may develop following lung transplantation (LTx). There is limited information on the management of MR in LTx patients, as such we sought to evaluate our centre’s experience.


      From 2000 to 2019, 1,054 patients underwent LTx at our centre (896 bilateral, 158 single). We identified patients in whom significant MR developed at any point post-LTx. The aetiology of MR, management and outcome were retrospectively analysed.


      Eight (8) patients developed severe MR post-LTx, six following bilateral LTx and two following single LTx. Lung transplantation indications included interstitial lung disease (n=5), chronic obstructive pulmonary disease (n=2) and pulmonary arterial hypertension (n=1). Severe MR occurred intraoperatively (n=1), postoperative day 1 (n=1) with the remaining six cases between 80 and 263 days post-LTx. The aetiology was noted to be due to severe left ventricular dysfunction following unmasking of a chronically pulmonary hypertension-related under-preloaded left ventricle in one case, and in the remaining seven patients causes included myxomatous degeneration, ischaemic MR, and functional MR due to annular dilatation. In the patient with intraoperative severe MR, the MR became mild with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and in the remaining seven patients a variety of procedures were used, including mitral valve repair, valve replacement and transcatheter edge-to-edge mitral valve repair. All patients survived the mitral procedure. Two (2) deaths occurred at 12.9 years (stroke) and 5 years (cancer) from mitral valve surgery.


      Development of significant mitral valve regurgitation is a rare but morbid complication after lung transplantation. This may represent the progressive natural history of pre-existing degenerative mitral valve disease and rarely, early after transplantation may be related to changes in ventricular geometry. Management of severe MR can follow the same management approach as in the non-transplant community, with the expectation of similarly good results.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hamad A.
        • Rizzardi G.
        • Bottio T.
        • Gerosa G.
        • Rea F.
        A word of caution for patients undergoing lung transplantation with associated mitral regurgitation.
        J Heart Lung Transplant. 2008; 27: 935-936
        • McCartney S.
        • Colin B.
        • Duane Davis R.
        • Del Rio J.
        • Swaminathan M.
        Pulmonary dysfunction after lung transplantation: the dilemma of coexisting mitral regurgitation.
        J Cardiothorac Vasc Anesth. 2014; 28: 1696-1699
        • Udoji T.
        • Force S.
        • Pelaez A.
        Severe mitral regurgitation unmasked after bilateral lung transplantation.
        Pulm Circ. 2013; 3: 696-699
        • Bermudez C.
        • Rocha R.
        • Katz W.
        • Toyoda Y.
        Novel mechanism of mitral regurgitation after lung transplantation in a patient with scleroderma and pulmonary hypertension.
        J Thorac Cardiovasc Surg. 2011; 141: e1-e3
        • McCartney S.
        • Cooter M.
        • Samad Z.
        • Sivak J.
        • Castleberry A.
        • Gregory S.
        • et al.
        Mitral regurgitation after orthotopic lung transplantation: natural history and impact on outcomes.
        J Cardiothorac Vasc Anesth. 2017; 31: 924-930
        • Zoghbi W.
        • Adams D.
        • Bonow R.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.
        • et al.
        Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance.
        J Am Soc Echocardiogr. 2017; 30: 303-371
        • Dziadzko V.
        • Clavel M.-A.
        • Dziadzko M.
        • Medina-Inojosa J.R.
        • Michelena H.
        • Maalouf J.
        • et al.
        Outcome and undertreatment of mitral regurgitation: a community cohort study.
        Lancet. 2018; 391: 960-969