Skip to main content
SpringerLink
Log in

Ischemic Mitral Regurgitation

  • Chapter
  • First Online:
Mitral Valve Surgery

  • 1331 Accesses

Abstract

Ischemic mitral regurgitation (IMR) is a functional problem, which results from ischemia of the ventricle. Except in the case of ischemic papillary muscle rupture, the mitral apparatus is anatomically normal and the regurgitation is solely caused by abnormal systolic motion of the ventricle, interfering with the normal closure physiology of the valve. This is an important precision as organic mitral valve disease can simply be concomitant to coronary artery disease: in this situation, the prognosis is usually much better than in IMR. To make the situation even more complex, IMR can aggravate a pre-existent organic disease. Precise echocardiographic diagnosis is therefore needed to distinguish the different components and consequences of the underlying disease process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ypenburg C, Lancellotti P, Tops LF, et al. Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation. J Am Coll Cardiol. 2007;50(21):2071-2077.

    Article  PubMed  Google Scholar 

  2. Ypenburg C, Lancellotti P, Tops LF, et al. Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy. Eur Heart J. 2008;29(6):757-765.

    Article  PubMed  Google Scholar 

  3. Miller GE Jr, Kerth WJ, Gerbode F. Experimental papillary muscle infarction. J Thorac Cardiovasc Surg. 1968;56(5): 611-616.

    PubMed  Google Scholar 

  4. Gorman RC, McCaughan JS, Ratcliffe MB, et al. Pathogenesis of acute ischemic mitral regurgitation in three dimensions. J Thorac Cardiovasc Surg. 1995;109(4): 684-693.

    Article  CAS  PubMed  Google Scholar 

  5. Komeda M, Glasson JR, Bolger AF, et al. Geometric determinants of ischemic mitral regurgitation. Circulation. 1997;96(9 Suppl):II-128-II-133.

    Google Scholar 

  6. Kaul S, Spotnitz WD, Glasheen WP. Mechanism of ischemic mitral regurgitation. An experimental evaluation. Circulation. 1991;84(5):2167-2180.

    CAS  PubMed  Google Scholar 

  7. Grigioni F, Detaint D, Avierinos JF, et al. Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol. 2005;45(2):260-267.

    Article  PubMed  Google Scholar 

  8. Grigioni F, Enriquez-Sarano M, Zehr KJ, et al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001;103(13):1759-1764.

    CAS  PubMed  Google Scholar 

  9. Lancellotti P, Gerard PL, Pierard LA. Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation. Eur Heart J. 2005;26(15):1528-1532.

    Article  PubMed  Google Scholar 

  10. Lamas GA, Mitchell GF, Flaker GC, et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators. Circulation. 1997;96(3):827-833.

    CAS  PubMed  Google Scholar 

  11. Lehmann KG, Francis CK, Dodge HT. Mitral regurgitation in early myocardial infarction. Incidence, clinical detection, and prognostic implications. TIMI Study Group. Ann Intern Med. 1992;117(1):10-17.

    CAS  PubMed  Google Scholar 

  12. Trichon BH, Felker GM, Shaw LK, et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol. 2003;91(5):538-543.

    Article  PubMed  Google Scholar 

  13. Guy TSt, Moainie SL, Gorman JH 3rd, et al. Prevention of ischemic mitral regurgitation does not influence the outcome of remodeling after posterolateral myocardial infarction. J Am Coll Cardiol. 2004;43(3):377-383.

    Article  PubMed  Google Scholar 

  14. Frater RW. Ischemic mitral regurgitation. J Heart Valve Dis. 1993;2(6):706.

    CAS  PubMed  Google Scholar 

  15. Bolling SF, Deeb GM, Brunsting LA, et al. Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardiovasc Surg. 1995;109(4):676-682. discussion 682–673.

    Article  CAS  PubMed  Google Scholar 

  16. Christenson JT, Simonet F, Bloch A, et al. Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not? J Heart Valve Dis. 1995;4(5):484-488. discussion 488–489.

    CAS  PubMed  Google Scholar 

  17. Aklog L, Filsoufi F, Flores KQ, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation. 2001;104(12 Suppl 1):I68-I75.

    CAS  PubMed  Google Scholar 

  18. Czer LS, Maurer G, Bolger AF, et al. Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography. Tex Heart Inst J. 1996;23(4):270-278.

    CAS  PubMed  Google Scholar 

  19. Lam BK, Gillinov AM, Blackstone EH, et al. Importance of moderate ischemic mitral regurgitation. Ann Thorac Surg. 2005;79(2):462-470. discussion 462–470.

    Article  PubMed  Google Scholar 

  20. McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004; 128(6):916-924.

    PubMed  Google Scholar 

  21. Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol. 2007;49(22):2191-2201.

    Article  PubMed  Google Scholar 

  22. Geidel S, Lass M, Schneider C, et al. Downsizing of the mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling. Eur J Cardiothorac Surg. 2005; 27(6):1011-1016.

    Article  PubMed  Google Scholar 

  23. Geidel S, Schneider C, Lass M, et al. Changes of myocardial function after combined coronary revascularization and mitral valve downsizing in patients with ischemic mitral regurgitation and advanced cardiomyopathy. Thorac Cardiovasc Surg. 2007;55(1):1-6.

    Article  CAS  PubMed  Google Scholar 

  24. Gelsomino S, Lorusso R, Capecchi I, et al. Left ventricular reverse remodeling after undersized mitral ring annuloplasty in patients with ischemic regurgitation. Ann Thorac Surg. 2008;85(4):1319-1330.

    Article  PubMed  Google Scholar 

  25. Serri K, Bouchard D, Demers P, et al. Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair? J Thorac Cardiovasc Surg. 2006; 131(3):565-573. e562.

    Article  CAS  PubMed  Google Scholar 

  26. Braun J, van de Veire NR, Klautz RJ, et al. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg. 2008;85(2):430-436. discussion 436–437.

    Article  PubMed  Google Scholar 

  27. Dion R, Benetis R, Elias B, et al. Mitral valve procedures in ischemic regurgitation. J Heart Valve Dis. 1995;4(Suppl 2):S124-S129. discussion S129–131.

    PubMed  Google Scholar 

  28. Prifti E, Bonacchi M, Frati G, et al. Ischemic mitral valve regurgitation grade II-III: correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization. J Heart Valve Dis. 2001;10(6):754-762.

    CAS  PubMed  Google Scholar 

  29. Prifti E, Bonacchi M, Frati G, et al. Should mild-to-moderate and moderate ischemic mitral regurgitation be corrected in patients with impaired left ventricular function undergoing simultaneous coronary revascularization? J Card Surg. 2001;16(6):473-483.

    Article  CAS  PubMed  Google Scholar 

  30. Gillinov AM, Wierup PN, Blackstone EH, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2001;122(6):1125-1141.

    Article  CAS  PubMed  Google Scholar 

  31. Calafiore AM, Di Mauro M, Gallina S, et al. Mitral valve surgery for chronic ischemic mitral regurgitation. Ann Thorac Surg. 2004;77(6):1989-1997.

    Article  PubMed  Google Scholar 

  32. Akins CW, Hilgenberg AD, Buckley MJ, et al. Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg. 1994;58(3):668-675. discussion 675–666.

    Article  CAS  PubMed  Google Scholar 

  33. Messas E, Guerrero JL, Handschumacher MD, et al. Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation. Circulation. 2001;104(16):1958-1963.

    Article  CAS  PubMed  Google Scholar 

  34. Borger MA, Murphy PM, Alam A, et al. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007;133(6):1483-1492.

    Article  PubMed  Google Scholar 

  35. Alfieri O, De Bonis M, Lapenna E, et al. “Edge-to-edge” repair for anterior mitral leaflet prolapse. Semin Thorac Cardiovasc Surg. 2004;16(2):182-187.

    Article  PubMed  Google Scholar 

  36. Ueno T, Sakata R, Iguro Y, et al. New surgical approach to reduce tethering in ischemic mitral regurgitation by relocation of separate heads of the posterior papillary muscle. Ann Thorac Surg. 2006;81(6):2324-2325.

    Article  PubMed  Google Scholar 

  37. Langer F, Schäfers HJ. RING plus STRING: papillary muscle repositioning as an adjunctive repair technique for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007;133(1):247-249.

    Article  PubMed  Google Scholar 

  38. Rama A, Praschker L, Barreda E, et al. Papillary muscle approximation for functional ischemic mitral regurgitation. Ann Thorac Surg. 2007;84(6):2130-2131.

    Article  PubMed  Google Scholar 

  39. Hung J, Chaput M, Guerrero JL, et al. Persistent reduction of ischemic mitral regurgitation by papillary muscle repositioning: structural stabilization of the papillary muscle-ventricular wall complex. Circulation. 2007;116(11 Suppl): I259-I263.

    PubMed  Google Scholar 

  40. Langer F, Rodriguez F, Cheng A, et al. Posterior mitral leaflet extension: an adjunctive repair option for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2006;131(4):868-877.

    Article  PubMed  Google Scholar 

  41. Grossi EA, Woo YJ, Schwartz CF, et al. Comparison of Coapsys annuloplasty and internal reduction mitral annuloplasty in the randomized treatment of functional ischemic mitral regurgitation: impact on the left ventricle. J Thorac Cardiovasc Surg. 2006;131(5):1095-1098.

    Article  CAS  PubMed  Google Scholar 

  42. Di Donato M, Sabatier M, Dor V, et al. Akinetic versus dyskinetic postinfarction scar: relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair. J Am Coll Cardiol. 1997;29(7):1569-1575.

    Article  PubMed  Google Scholar 

  43. Menicanti L, Castelvecchio S, Ranucci M, et al. Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration. J Thorac Cardiovasc Surg. 2007;134(2):433-441.

    Article  PubMed  Google Scholar 

  44. Starling RC, Jessup M, Oh JK, et al. Sustained benefits of the CorCap Cardiac Support Device on left ventricular remodeling: three year follow-up results from the Acorn clinical trial. Ann Thorac Surg. 2007;84(4):1236-1242.

    Article  PubMed  Google Scholar 

  45. Suma H, Tanabe H, Uejima T, et al. Selected ventriculoplasty for idiopathic dilated cardiomyopathy with advanced congestive heart failure: midterm results and risk analysis. Eur J Cardiothorac Surg. 2007;32(6):912-916.

    Article  PubMed  Google Scholar 

  46. Kang DH, Kim MJ, Kang SJ, et al. Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. Circulation. 2006;114(1 Suppl):I499-I503.

    PubMed  Google Scholar 

  47. Diodato MD, Moon MR, Pasque MK, et al. Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis. Ann Thorac Surg. 2004;78(3):794-799. discussion 794–799.

    Article  PubMed  Google Scholar 

  48. Grayburn PA, Appleton CP, DeMaria AN, et al. Echocardiographic predictors of morbidity and mortality in patients with advanced heart failure: the Beta-blocker Evaluation of Survival Trial (BEST). J Am Coll Cardiol. 2005;45(7):1064-1071.

    Article  PubMed  Google Scholar 

  49. Hinderliter AL, Blumenthal JA, O’Conner C, et al. Independent prognostic value of echocardiography and N-terminal pro-B-type natriuretic peptide in patients with heart failure. Am Heart J. 2008;156(6):1191-1195.

    Article  PubMed  Google Scholar 

  50. St John Sutton M, Pfeffer MA, Moye L, et al. Cardiovascular death and left ventricular remodeling two years after myocardial infarction: baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement (SAVE) trial. Circulation. 1997; 96(10):3294-3299.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Robert J. M. Klautz

Authors
  1. Robert J. M. Klautz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A. E. Dion
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. M. Klautz .

Editor information

Editors and Affiliations

  1. Dept. Cardiothoracic Surgeon, Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom

    Robert S. Bonser

  2. Cardiothoracic Surgery, Beaumont Road 208, Birmingham, B30 1NX, United Kingdom

    Domenico Pagano

  3. Klinik für Herz-, Thorax-,, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, Hannover, 30625, Germany

    Axel Haverich

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited

About this chapter

Cite this chapter

Klautz, R.J.M., Dion, R.A.E. (2010). Ischemic Mitral Regurgitation. In: Bonser, R., Pagano, D., Haverich, A. (eds) Mitral Valve Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-426-5_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-84996-426-5_10

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84996-425-8

  • Online ISBN: 978-1-84996-426-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation