Mitral valve repair for ischemic mitral incompetence

  • R. Hetzer
  • E.M. Delmo Walter


Ischemic mitral incompetence (IMI) is the most frequent mechanism of mitral regurgitation today and will continue to be so in the future, particularly in developed countries where rheumatic mitral valve disease has been nearly eradicated. It is a complex multifactorial entity related to coronary artery disease that is a frequent complication of myocardial infarction and associated with a poor prognosis. It involves global and regional left ventricular remodeling as well as dysfunction and distortion of the mitral valve (MV), including the chordae, annulus, and leaflets. Mitral regurgitation in the IMI mechanism is characterized by restrictive mitral leaflet mobility due to dyskinesia or even akinesia of the ventricular wall which bears one or both papillary muscles, thus, extending the distance between the ventricular wall and the leaflets, either both or, most frequently, predominantly the posterior leaflet. The posterior papillary muscle and its supporting ventricular wall and the posterior–inferior wall of the left ventricle are most frequently affected.


Mitral Valve Mitral Regurgitation Papillary Muscle Mitral Valve Replacement Mitral Valve Repair 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hetzer R, Delmo Walter EM (2010) Repair of congenital mitral valve insufficiency. Oper TechThorac Cardiovasc Surg A Comparative Atlas.15(4)260–272Google Scholar
  2. 2.
    Bolling SF (2001) Mitral valve reconstruction in the patient with heart failure. Heart Failure Reviews 6:177–185PubMedCrossRefGoogle Scholar
  3. 3.
    Gerbode FL, Hetzer R, Krebber HJ (1978) Surgical management of papillary muscle rupture to myocardial infarction. World J Surg 2:791–796PubMedCrossRefGoogle Scholar
  4. 4.
    Duarte IG, Murphy CO, Kosinski AS, Jnes EL, Craver JM, Gott JP, Guyton RA (1997) Late survival after valve operation in patients with left ventricular dysfunction. Ann Thorac Surg 64:1089–1095PubMedCrossRefGoogle Scholar
  5. 5.
    Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM (2005) Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol 45:388–390CrossRefGoogle Scholar
  6. 6.
    Bishay ES, McCarthy PM, Cosgrove DM, et al. (2000) Mitral valve surgery in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg 17:213–221PubMedCrossRefGoogle Scholar
  7. 7.
    Rostagno C, Caciolli S, Fradella GF, Stefano PL (2007) Early effects of mitral valve repair in patients with left ventricular dysfunction: an echocardiographic study. Eur J Heart Fail(suppl):26Google Scholar
  8. 8.
    Duarte IG, Shen Y, MacDonald MJ, Jones EL, Craver JM, Guyton RA (1999) Treatment of moderate regurgitation and coronary disease by coronary bypass alone: late results. Ann Thorac Surg 68:426–430PubMedCrossRefGoogle Scholar
  9. 9.
    Jones EL, Weintraub WS, Craver JM, Guyton RA, Shen Y (1994) Interaction of age and coronary disease after valve replacement: implications for valve selection. Ann Thorac Surgery 58:378–385CrossRefGoogle Scholar
  10. 10.
    Ashraff SS, Shaukat N, Odom N, Keenan D, Grotte G (1994) Early and late results following combined coronary bypass surgery and mitral valve replacement. Eur J Cardiothorac Surg 8:57–162CrossRefGoogle Scholar
  11. 11.
    Hendren WC, Nemec JJ, Lytle BW, Loop FD, Taylor PC, Stewart RW, Cosgrove DM (1991) Mitral valve repair for ischemic mitral insufficiency. Ann Thorac Surg 52:1246–1252PubMedCrossRefGoogle Scholar
  12. 12.
    Kay GL, Kay JH, Zubiate P, Yokoyama T, Mendez M (1986) Mitral valve repair for mitral regurgitation secondary to artery disease. Circulation 74(suppl I):88–98Google Scholar
  13. 13.
    Rankin JS, Livesey SA, smith LR, et al. (1989) Trends in the surgical treatment of ischemic mitral regurgitation: effects of mitral valve repair on hospital mortality. Semin Thorac Cardiovasc Surg 1:149–163PubMedGoogle Scholar
  14. 14.
    Von Oppell UO, Stemmet F, Brink J, Commerford PJ, Heijke SA (2000) Ischemic mitral valve surgery. J Heart Valve Dis 9:64–73Google Scholar
  15. 15.
    Lee EM, Shapiro LM, Well FC (1995) Mortality and morbidity after mitral valve repair. The importance of left ventricular function. J Heart Valve Dis 4:460–468PubMedGoogle Scholar
  16. 16.
    Rankin JS, Hickey MSJ, Smith LR, DeBruijn NP, Sheikh KH, Sabiston DC (1991) Current concepts in the pathogenesis and treatment of ischemic mitral regurgitation. In: Vetter, Hetzer, Schmutzler (eds) Ischemic Mitral Incompetence. Springer Verlag, Heidelberg, pp 127–178Google Scholar
  17. 17.
    Menicanti L, Di Donato M, Frigiola A, Buckberg G, Santambrogio C, Ranucci M, Santo D, RESTORE roup (2002) Ischemic mitral regurgitation: intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration. J Cardiothorac Surg123:1041–1050Google Scholar
  18. 18.
    Rothenburger M, Rokusujew A, Hammel D, Dorenkamp A, Scheld HH (2002) Mitral valve surgery in patients with poor left ventricular dysfunction. Thorac Cardiovasc Surg 6:351–354CrossRefGoogle Scholar
  19. 19.
    Szalay ZA. Civelek A, Hobe S, Brunner-LaRocca HP, Klovekorn WP, Knez I, Vogt PR, Bauer EP (2003) Mitral annuloplasty in patients with ischemic versus dilated cardiomyopathy. Eur J Cardiothorac Surg 4:567–572CrossRefGoogle Scholar
  20. 20.
    Chen F, Adams D, Aranki S, Collins J, Couper G, Rizzo R, Cohn L (1998) Mitral valve repair in cardiomyopathy. Circulation 98:II124–II127PubMedGoogle Scholar
  21. 21.
    Lachmann J, Shirani J, Pletis K, Frater R, Le Jemtel T (2001) Mitral ring annuloplasty: an incomplete correction of functional mitral regurgitation associated with left ventricular remodeling. Curr Cardiol Rep 3:241–246PubMedCrossRefGoogle Scholar
  22. 22.
    Bolling S (2002) Mitral reconstruction in cardiomyopathy. J Heart Valve Dis 11:S25–S31Google Scholar
  23. 23.
    Silberman S, Klutstein MW, Sabag T, Oren A, Fink D, Merin O, Bitran D (2009) Repair of ischemic mitral regurgitation: comparison between flexible and rigid annuloplasty rings. Ann Thorac Surg 87:1721–1727PubMedCrossRefGoogle Scholar
  24. 24.
    Hetzer R, Drews T, S iniawski H, Komoda T, Hofmeister J, Weng Y (1995). preservation of papillary muscles and chordae during mitral valve replacement: possibilities and limitations. J Heart Valve Disease 4(Suppl II):S115–S123Google Scholar
  25. 25.
    David TE, Uden DE, Strauss HD (1983) The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 68(3 pt 2):1176–1182Google Scholar
  26. 26.
    Sarris GE, Cahill PD, Hansen DE, Derby GC, Miller DC (1988) Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. The importance of valvular-ventricular interaction. J Thorac Cardiovasc Surg 95:969–979PubMedGoogle Scholar
  27. 27.
    Huikuri HV (1983) Effect of mitral valve replacement on left ventricular function in mitral regurgitation. Br Heart J 49:328–333PubMedCrossRefGoogle Scholar
  28. 28.
    Tischler MD, Cooper KA, Rowen M, Le Winter MM (1994) Myocardial function/valvular heart disease/hypertensive heart disease: mitral valve replacement versus mitral valve repair: a Doppler and quantitative stress echocardiographic study. Circulation 89:132–137PubMedGoogle Scholar
  29. 29.
    Hausmann H, Siniawski H, Hotz H, Hofmeister J, Chavez T, Schmidt G, Hetzer R (1997) Mitral valve reconstruction and mitral valve replacement in ischemic mitral insufficiency. J Card Surg 12:8–14PubMedCrossRefGoogle Scholar
  30. 30.
    Hausmann H, Siniawski H, Hetzer R (1999) Mitral valve reconstruction and replacement for ischemic mitral insufficiency: seven years’ follow-up. J Heart Valve Dis 8:536–542PubMedGoogle Scholar
  31. 31.
    Prifti E, Bonacchi M, Frati G, et al. (2000) Early and midterm outcome of coronary artery bypass grafting in endstage coronary artery disease patients. Cor Europaeum 8:93–99Google Scholar
  32. 32.
    Czer LS, Maurer G, Bolger AF, De Robertis M, Chaux A, Matloff JM (1996) Revascularization alone or in combined with suture annuloplasty for ischemic mitral regurgitation: evaluation by color Doppler echocardiography. Tex heart Inst J 23:270–278PubMedGoogle Scholar
  33. 33.
    Christenson JT, Simonet F, Bloch A, Maurice J, Schmuziger M (1995) Should a mild to moderate mitral valve regurgitation in patients with poor left ventricular function be repaired or not. J Heart Valve Dis 4:484–488PubMedGoogle Scholar
  34. 34.
    Pinson CW Cobanoglu A, Metzdorff MT, Grunkemeier GL, Kay PH, Starr A (1984) Late surgical results for ischemic mitral regurgitation. Role of wall motion score and severity of regurgitation. J Thorac Cardiovasc Surg 88:663–672PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • R. Hetzer
    • 1
  • E.M. Delmo Walter
    • 2
  1. 1.Deutsches Herzzentrum BerlinCharité Medical University BerlinBerlinGermany
  2. 2.Department of Cardiothoracic and Vascular SurgeryDeutsches Herzzentrum BerlinBerlinGermany

Personalised recommendations