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When Should Patients with Ischemic Mitral Regurgitation Undergo Cardiac Surgery?

  • Scipione Carerj
  • Concetta Zito
  • Giuseppe Dattilo
  • Gianluca Di Bella
  • Carmelo Nipote
  • Annalisa Lamari
  • Rossella Garufi
  • Salvatore Micciulla
  • Francesco Arrigo
Conference paper

Abstract

Ischemic mitral regurgitation (MR) is a frequent entity that is often overlooked in the setting of acute or chronic coronary disease [1, 2]. The prevalence of this disorder varies between 10 and 30% of MR cases. The papillary muscles are particularly jeopardized by acute ischemia, and the posteromedial muscle (perfused by the posterior descending coronary artery) is more vulnerable than the anterolateral one (perfused by branches of the anterior and circumflex coronary arteries). The posteromedial muscle is perfused by one vessel in 63% of patients, whereas the anterolateral muscle receives blood from the two major coronary branches in 73% of patients [3]. MR following acute myocardial infarction (AMI) develops in 15% of patients suffering from an anterior insult as compared to 40% of those with an inferior infarction. Functional MR after the ischemic insult, or induced by myocardial ischemia and transient papillary-muscle-related myocardial wall dysfunction, is therefore characterized by preserved valve integrity.

Keywords

Mitral Regurgitation Papillary Muscle Severe Mitral Regurgitation Functional Mitral Regurgitation Ischemic Mitral Regurgitation 
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.

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References

  1. 1.
    Grigioni F, Enriquez-Sarano M, Zehr KJ et al (2001) Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 103:1759–1764PubMedGoogle Scholar
  2. 2.
    Levine RA, Scwammenthal E (2005) Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation 112:745–758PubMedCrossRefGoogle Scholar
  3. 3.
    Voci P, Bilotta F, Caretta O et al (1995) Papillary muscles perfusion pattern. A hypothesis for ischemic papillary muscle dysfunction. Circulation 91:1714–1718PubMedGoogle Scholar
  4. 4.
    Gorman 3rd JH, Gorman RC, Plappert T et al (1998) Infarct size and location determine development of mitral regurgitation in the sheep model. J Thorac Cardiovasc Surg 115:615–622PubMedCrossRefGoogle Scholar
  5. 5.
    Gorman 3rd JH, Jackson BM, Gorman RC et al (1997) Papillary muscle discoordination rather than increased annular area facilitates mitral regurgitation after posterior myocardial infarction. Circulation 96(Suppl):II124–II127Google Scholar
  6. 6.
    Agricola E, Oppizzi M, Maisano F et al (2004) Echocardiographic classification of chronic mitral regurgitation caused by restricted motion according to tethering pattern. Eur J Echocardiogr 5:326–334PubMedCrossRefGoogle Scholar
  7. 7.
    Lancellotti P, Lebois F, Simon M et al (2003) Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischaemic left ventricular dysfunction. Circulation 108:1713–1717PubMedCrossRefGoogle Scholar
  8. 8.
    Pu M, Thomas JD, Gillinov MA et al (2003) Importance of ischaemic and viable myocardium for patients with chronic ischaemic mitral regurgitation and left ventricular dysfunction. Am J Cardiol 92:862–864PubMedCrossRefGoogle Scholar
  9. 9.
    Enrique-Sarano M, Schaff HV, Frye RL (2003) Mitral regurgitation: what causes the leakage is fundamental to the outcome of valve repair. Circulation 108:253–256CrossRefGoogle Scholar
  10. 10.
    Yacoub MH, Cohn LH (2004) Novel approaches to cardiac valve repair: from structure to function. Part I. Circulation 109:942–950PubMedCrossRefGoogle Scholar
  11. 11.
    Al-Radi OO, Austin PC, Tu JV et al (2005) Mitral repair versus replacement for ischemic mitral regurgitation. Ann Thorac Surg 79:1260–1267PubMedCrossRefGoogle Scholar
  12. 12.
    Lung B (2003) Management of ischaemic mitral regurgitation. Heart 89:459–464CrossRefGoogle Scholar
  13. 13.
    The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (2007) Guidelines on the management of valvular heart disease. Eur Heart J 28:230–268CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Scipione Carerj
    • 1
  • Concetta Zito
    • 1
  • Giuseppe Dattilo
    • 1
  • Gianluca Di Bella
    • 1
  • Carmelo Nipote
    • 1
  • Annalisa Lamari
    • 1
  • Rossella Garufi
    • 1
  • Salvatore Micciulla
    • 1
  • Francesco Arrigo
    • 1
  1. 1.Cardiology DepartmentUniversity of MessinaMessinaItaly

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