Ischemic Mitral Regurgitation

  • Robert J. M. KlautzEmail author
  • Robert A. E. Dion


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.


Mitral Valve Coronary Artery Bypass Grafting Mitral Regurgitation Mitral Valve Replacement Mitral Annulus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 3.
    Miller GE Jr, Kerth WJ, Gerbode F. Experimental papillary muscle infarction. J Thorac Cardiovasc Surg. 1968;56(5): 611-616.PubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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. 6.
    Kaul S, Spotnitz WD, Glasheen WP. Mechanism of ischemic mitral regurgitation. An experimental evaluation. Circulation. 1991;84(5):2167-2180.PubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 14.
    Frater RW. Ischemic mitral regurgitation. J Heart Valve Dis. 1993;2(6):706.PubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.PubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefPubMedGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.PubMedGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.CrossRefPubMedGoogle Scholar
  43. 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.CrossRefPubMedGoogle Scholar
  44. 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.CrossRefPubMedGoogle Scholar
  45. 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.CrossRefPubMedGoogle Scholar
  46. 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.PubMedGoogle Scholar
  47. 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.CrossRefPubMedGoogle Scholar
  48. 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.CrossRefPubMedGoogle Scholar
  49. 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.CrossRefPubMedGoogle Scholar
  50. 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.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations