{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:23:07Z","timestamp":1790144587458,"version":"4.0.1"},"reference-count":68,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Mitral valve closure is a complex process and requires coordinated actions of all its interrelated anatomical components: the left atrium, the mitral annulus, the valve leaflets, the tendinous chordae, and the papillary muscles with its surrounding left ventricular wall for an effective mitral valve closure. Research of last three-decades has shown that the mitral annulus starts contracting during atrial systole which significantly prevent early mitral regurgitation (MR). MR can be acute or chronic, and primary, or secondary or mixed; their etiologies, mechanisms and natural progression are very different and have clinical implications. A leaflet perforation, a rupture of chorda tendinea or papillary muscle and a torn leaflet after balloon mitral valvotomy can result in acute severe MR. The patients of acute severe MR present in pulmonary edema and cardiogenic shock and often need urgent surgical intervention. Primary MR is a disease of the mitral valve apparatus and secondary to valve degeneration, whereas secondary MR is a disease of the left ventricle secondary to coronary artery disease and dilated cardiomyopathy. The other causes of secondary MR include mitral annular dilation secondary to atrial fibrillation and restrictive cardiomyopathy, dys-synchrony due to bundle branch block, right ventricular pacing and hypertrophic cardiomyopathy. The treatment strategy differs for primary and various subsets of secondary MR; hence, a thorough knowledge of the etiology, mechanisms and pathogenesis of MR is necessary to select appropriate management strategy and to decide when to intervene. The review discusses the mechanisms, and pathophysiology in acute, chronic, primary and secondary MR.<\/jats:p>","DOI":"10.4103\/aca.aca_221_24","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T11:00:12Z","timestamp":1744801212000},"page":"109-118","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["The Mechanisms and Pathophysiology of Mitral Regurgitation: A Narrative Review"],"prefix":"10.4103","volume":"28","author":[{"given":"Praveen Kumar","family":"Neema","sequence":"first","affiliation":[{"name":"Department of Cardiac Anaesthesia, Amrita Institute for Medical Sciences, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagarjuna","family":"Panidapu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesia, Amrita Institute for Medical Sciences, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"R1-20250416","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.echo.2014.01.005","article-title":"Intraoperative transesophageal echocardiography for surgical repair of mitral regurgitation","volume":"27","author":"Sidebotham","year":"2014","journal-title":"J Am Soc Echocardiogr"},{"key":"R2-20250416","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/1089253208316442","article-title":"Anesthetic considerations in the patient with valvular heart disease undergoing noncardiac surgery","volume":"12","author":"Mittnacht","year":"2008","journal-title":"Semin Cardiothorac Vasc Anesth"},{"key":"R3-20250416","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/0735-1097(92)90166-K","article-title":"Mitral regurgitation due to ruptured chordae tendineae in patients with hypertrophic obstructive cardiomyopathy","volume":"20","author":"Zhu","year":"1992","journal-title":"J Am Coll Cardiol"},{"key":"R4-20250416","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.acvd.2015.01.003","article-title":"Rupture of mitral valve chordae in hypertrophic cardiomyopathy","volume":"108","author":"Boissier","year":"2015","journal-title":"Arch Cardiovasc Dis"},{"key":"R5-20250416","doi-asserted-by":"crossref","first-page":"432","DOI":"10.4103\/aca.ACA_58_17","article-title":"Ischemic mitral regurgitation","volume":"20","author":"Varma","year":"2017","journal-title":"Ann Card Anaesth"},{"key":"R6-20250416","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1093\/ejcts\/ezs029","article-title":"Mitral valve repair for severe mitral regurgitation secondary to lone atrial fibrillation","volume":"42","author":"Vohra","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"key":"R7-20250416","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jcmg.2020.06.049","article-title":"Basic principles of the echocardiographic evaluation of mitral regurgitation","volume":"14","author":"Grayburn","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"R8-20250416","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199907013410101","article-title":"Prevalence and clinical outcome of mitral-valve prolapse","volume":"341","author":"Freed","year":"1999","journal-title":"N Engl J Med"},{"key":"R9-20250416","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0002-9149(98)01064-9","article-title":"Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)","volume":"83","author":"Singh","year":"1999","journal-title":"Am J Cardiol"},{"key":"R10-20250416","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/2394-7438.166304","article-title":"Mechanisms and pathophysiology of mitral valve regurgitation","volume":"1","author":"Neema","year":"2015","journal-title":"MAMC J Med Sci"},{"key":"R11-20250416","first-page":"31","article-title":"Effect of atrial fibrillation on the dynamics of mitral annular area","volume":"12","author":"Pai","year":"2002","journal-title":"Heart Valve Disease"},{"key":"R12-20250416","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ahj.2012.05.014","article-title":"Anatomy, mechanics, and pathophysiology of the mitral annulus","volume":"164","author":"Silbiger","year":"2012","journal-title":"Am Heart J"},{"key":"R13-20250416","first-page":"115","article-title":"Most ovine mitral annular three-dimensional size reduction occurs before ventricular systole and is abolished with ventricular pacing","author":"Glasson","year":"1997","journal-title":"Circulation"},{"key":"R14-20250416","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1161\/01.CIR.64.1.113","article-title":"Size and motion of the mitral valve annulus in man. I. A two-dimensional echocardiographic method and findings in normal subjects","volume":"64","author":"Ormiston","year":"1981","journal-title":"Circulation"},{"key":"R15-20250416","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.echo.2018.11.009","article-title":"Mitral annular and left ventricular dynamics in atrial functional mitral regurgitation:A three-dimensional and speckle-tracking echocardiographic study","volume":"32","author":"Tang","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"R16-20250416","doi-asserted-by":"crossref","first-page":"10.1161","DOI":"10.1161\/CIRCIMAGING.115.003539","article-title":"Dynamic changes of the mitral valve annulus:New look at mitral valve diseases","volume":"8","author":"Hag\u00e8ge","year":"2015","journal-title":"Circ Cardiovasc Imaging"},{"key":"R17-20250416","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/S0003-4975(01)02702-3","article-title":"Experimental and clinical assessment of mitral annular area and dynamics:What are we actually measuring?","volume":"72","author":"Timek","year":"2001","journal-title":"Ann Thorac Surg"},{"key":"R18-20250416","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.ijcard.2019.11.129","article-title":"The anatomic substrate of mitral annular contraction","volume":"306","author":"Silbiger","year":"2020","journal-title":"Int J Cardiol"},{"key":"R19-20250416","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcmg.2021.05.019","article-title":"Mitral annular dynamics in AF versus sinus rhythm:Novel insights into the mechanism of AFMR","volume":"15","author":"Deferm","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"R20-20250416","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1161\/CIRCULATIONAHA.109.901181","article-title":"Mitral annular dynamics in myxomatous valve disease:New insights with real-time 3-dimensional echocardiography","volume":"121","author":"Grewal","year":"2010","journal-title":"Circulation"},{"key":"R21-20250416","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/j.1540-8191.2005.200329.x","article-title":"Evaluation of the mitral valve leaflet morphology after mitral valve reconstruction with a concept \u201ccoaptation length index.\u201d","volume":"20","author":"Yamauchi","year":"2005","journal-title":"J Card Surg"},{"key":"R22-20250416","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1161\/01.CIR.0000025426.39426.83","article-title":"Effect of annular shape on leaflet curvature in reducing mitral leaflet stress","volume":"106","author":"Salgo","year":"2002","journal-title":"Circulation"},{"key":"R23-20250416","first-page":"80","article-title":"The mitral valve:New insights into the clinical anatomy","volume":"4","author":"Muresian","year":"2006","journal-title":"Maedica A J Clin Med"},{"key":"R24-20250416","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S0735-1097(98)00570-1","article-title":"Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation:Physiologic insights from the proximal flow convergence technique","volume":"33","author":"Hung","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"R25-20250416","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S0022-5223(19)39144-5","article-title":"Cardiac valve surgery--the \u201cFrench correction\u201d","volume":"86","author":"Carpentier","year":"1983","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R26-20250416","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1038\/nrcardio.2015.161","article-title":"Mitral valve disease--morphology and mechanisms","volume":"12","author":"Levine","year":"2015","journal-title":"Nat Rev Cardiol"},{"key":"R27-20250416","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.echo.2013.08.025","article-title":"A new definition for an old entity:Improved definition of mitral valve prolapse using three-dimensional echocardiography and color-coded parametric models","volume":"27","author":"Addetia","year":"2014","journal-title":"J Am Soc Echocardiogr"},{"key":"R28-20250416","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1001\/jama.2013.8643","article-title":"Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets","volume":"310","author":"Suri","year":"2013","journal-title":"JAMA"},{"key":"R29-20250416","doi-asserted-by":"crossref","first-page":"100129","DOI":"10.1016\/j.shj.2022.100129","article-title":"Secondary Mitral Regurgitation:Cardiac Remodeling, Diagnosis, and Management","volume":"7","author":"Huang","year":"2022","journal-title":"Struct Heart"},{"key":"R30-20250416","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1136\/heartjnl-2018-313373","article-title":"Acute mitral regurgitation","volume":"105","author":"Watanabe","year":"2019","journal-title":"Heart"},{"key":"R31-20250416","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/ccd.24417","article-title":"Acute severe mitral regurgitation following balloon mitral valvotomy:Echocardiographic features, operative findings, and outcome in 50 surgical cases","volume":"81","author":"Nanjappa","year":"2013","journal-title":"Catheter Cardiovasc Interv"},{"key":"R32-20250416","first-page":"161","article-title":"Assessment and management of acute severe mitral regurgitation in the intensive care unit","volume":"26","author":"Leitman","year":"2017","journal-title":"J Heart Valve Dis"},{"key":"R33-20250416","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/s12928-018-0555-4","article-title":"Acute severe mitral regurgitation with cardiogenic shock following balloon mitral valvuloplasty:Echocardiographic findings and outcomes following surgery","volume":"34","author":"Pillai","year":"2019","journal-title":"Cardiovasc Interv Ther"},{"key":"R34-20250416","doi-asserted-by":"crossref","first-page":"E72","DOI":"10.1161\/CIR.0000000000000923","article-title":"2020 ACC\/AHA Guideline for the management of patients with valvular heart disease:A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"R35-20250416","first-page":"36","article-title":"Mitral regurgitation","volume":"140","author":"Pedrazzini","year":"2010","journal-title":"Swiss Med Wkly"},{"key":"R36-20250416","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1161\/01.CIR.85.5.1651","article-title":"Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy","volume":"85","author":"Klues","year":"1992","journal-title":"Circulation"},{"key":"R37-20250416","first-page":"835","article-title":"Hypertrophic cardiomyopathy:Mechanisms of mitral regurgitation. 25. Current Treatment Options in Cardiovascular Medicine","author":"Galazka","year":"2023","journal-title":"Springer"},{"key":"R38-20250416","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1016\/j.jacc.2016.01.071","article-title":"The mitral valve in obstructive hypertrophic cardiomyopathy:A test in context","volume":"67","author":"Sherrid","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"R39-20250416","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1161\/CIRCULATIONAHA.107.755942","article-title":"Left ventricular response to mitral regurgitation implications for management","volume":"118","author":"Gaasch","year":"2008","journal-title":"Circulation"},{"key":"R40-20250416","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1161\/01.RES.28.1.49","article-title":"Diastolic geometry and sarcomere lengths in the chronically dilated canine left ventricle","volume":"28","author":"Ross","year":"1971","journal-title":"Circ Res"},{"key":"R41-20250416","first-page":"H65","article-title":"Mechanisms of cardiac hypertrophy in canine volume overload","volume":"275","author":"Matsuo","year":"1998","journal-title":"Am J Physiol"},{"key":"R42-20250416","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/S0022-5223(19)33992-3","article-title":"Structural basis for changes in left ventricular function and geometry because of chronic mitral regurgitation and after correction of volume overload","volume":"106","author":"Spinale","year":"1993","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R43-20250416","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0735-1097(85)80418-6","article-title":"Afterload mismatch in aortic and mitral valve disease:Implications for surgical therapy","volume":"5","author":"Ross","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"R44-20250416","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/S0735-1097(02)01763-1","article-title":"Angiotensin II receptor blockade does not improve left ventricular function and remodeling in subacute mitral regurgitation in the dog","volume":"39","author":"Perry","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"R45-20250416","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1161\/01.RES.70.1.131","article-title":"Cellular and ventricular contractile dysfunction in experimental canine mitral regurgitation","volume":"70","author":"Urabe","year":"1992","journal-title":"Circ Res"},{"key":"R46-20250416","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00018-013-1349-6","article-title":"The pathogenesis of cardiac fibrosis","volume":"71","author":"Kong","year":"2014","journal-title":"Cell Mol Life Sci"},{"key":"R47-20250416","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2011\/179057","article-title":"b-adrenergic receptor-stimulated cardiac myocyte apoptosis:Role of b1 integrins","volume":"2011","author":"Amin","year":"2011","journal-title":"J Signal Transduct"},{"key":"R48-20250416","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5830\/CVJA-2017-009","article-title":"Left ventricular remodelling in chronic primary mitral regurgitation:Implications for medical therapy","volume":"29","author":"Mccutcheon","year":"2018","journal-title":"Cardiovasc J Afr"},{"key":"R49-20250416","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.yjmcc.2009.06.001","article-title":"Extracellular matrix remodeling during the progression of volume overload-induced heart failure","volume":"48","author":"Hutchinson","year":"2010","journal-title":"J Mol Cell Cardiol"},{"key":"R50-20250416","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1161\/01.CIR.41.5.817","article-title":"Quantitative angiocardiography. IV. Relationships of left atrial and ventricular pressure and volume in mitral valve disease","volume":"41","author":"Kennedy","year":"1970","journal-title":"Circulation"},{"key":"R51-20250416","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1161\/CIRCIMAGING.110.961011","article-title":"Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study","volume":"4","author":"Rusinaru","year":"2011","journal-title":"Circ Cardiovasc Imaging"},{"issue":"(Suppl 4)","key":"R52-20250416","first-page":"iv1","article-title":"Quantitation of mitral regurgitation:Rationale, approach, and interpretation in clinical practice","volume":"88","author":"Enriquez-Sarano","year":"2002","journal-title":"Heart"},{"key":"R53-20250416","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-8703(51)90002-6","article-title":"Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I","volume":"41","author":"Gorlin","year":"1951","journal-title":"Am Heart J"},{"key":"R54-20250416","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s10554-020-02065-3","article-title":"Myocardial adaptation as assessed by speckle tracking echocardiography after isolated mitral valve surgery for primary mitral regurgitation","volume":"37","author":"Ger\u00e7ek","year":"2021","journal-title":"Int J Cardiovasc Imaging"},{"key":"R55-20250416","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0002-9149(98)01064-9","article-title":"Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)","volume":"83","author":"Singh","year":"1999","journal-title":"Am J Cardiol"},{"key":"R56-20250416","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1016\/j.jacc.2014.02.536","article-title":"2014 AHA\/ACC Guideline for the management of patients with valvular heart disease:A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"63","author":"Nishimura","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"R57-20250416","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jacc.2017.03.011","article-title":"2017 AHA\/ACC Focused Update of the 2014 AHA\/ACC Guideline for the Management of Patients With Valvular Heart Disease:A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"70","author":"Nishimura","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"R58-20250416","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/0002-8703(68)90097-5","article-title":"The syndrome of papillary muscle dysfunction","volume":"75","author":"Burch","year":"1968","journal-title":"Am Heart J"},{"key":"R59-20250416","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1161\/01.CIR.63.3.565","article-title":"Incomplete mitral leaflet closure in patients with papillary muscle dysfunction","volume":"63","author":"Godley","year":"1981","journal-title":"Circulation"},{"key":"R60-20250416","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1161\/01.CIR.68.3.498","article-title":"Quantitative echocardiography of the mitral complex in dilated cardiomyopathy:The mechanism of functional mitral regurgitation","volume":"68","author":"Boltwood","year":"1983","journal-title":"Circulation"},{"key":"R61-20250416","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/0735-1097(92)90302-4","article-title":"Mechanism of functional mitral regurgitation during acute myocardial ischemia","volume":"19","author":"Kono","year":"1992","journal-title":"J Am Coll Cardiol"},{"key":"R62-20250416","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/0002-8703(92)90703-X","article-title":"Left ventricular shape:A factor in the etiology of functional mitral regurgitation in heart failure","volume":"123","author":"Sabbah","year":"1992","journal-title":"Am Heart J"},{"key":"R63-20250416","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/0002-9149(91)90831-5","article-title":"Left ventricular shape as a determinant of functional mitral regurgitation in patients with severe heart failure secondary to either coronary artery disease or idiopathic dilated cardiomyopathy","volume":"68","author":"Kono","year":"1991","journal-title":"Am J Cardiol"},{"key":"R64-20250416","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1016\/0735-1097(92)90455-V","article-title":"Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure","volume":"20","author":"Kono","year":"1992","journal-title":"J Am Coll Cardiol"},{"key":"R65-20250416","first-page":"H266","article-title":"Left ventricular shape changes during the course of evolving heart failure","volume":"263","author":"Sabbah","year":"1992","journal-title":"Am J Physiol"},{"key":"R66-20250416","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.1161\/01.CIR.84.5.2167","article-title":"Mechanism of ischemic mitral regurgitation. An experimental evaluation","volume":"84","author":"Kaul","year":"1991","journal-title":"Circulation"},{"key":"R67-20250416","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1161\/CIRCULATIONAHA.104.486720","article-title":"Ischemic mitral regurgitation on the threshold of a solution:From paradoxes to unifying concepts","volume":"112","author":"Levine","year":"2005","journal-title":"Circulation"},{"key":"R68-20250416","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1161\/01.CIR.90.1.307","article-title":"Dynamics of mitral regurgitant flow and orifice area. Physiologic application of the proximal flow convergence method:clinical data and experimental testing","volume":"90","author":"Schwammenthal","year":"1994","journal-title":"Circulation"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_221_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:34:02Z","timestamp":1786736042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_221_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":68,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_221_24","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-11-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-19","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}