Abstract
Ischemic mitral regurgitation (MR) is mitral regurgitation due to complications of coronary artery disease, in particular myocardial infarction (MI), and not the fortuitous association of coronary artery disease with intrinsic valve disease such as degenerative, myxomatous, and connective tissue valvular disease, spontaneous ruptured chordae tendinae, and other causes of acute or chronic MR due to infection, inflammation, trauma, congenital abnormalities (including mitral valve (MV) prolapse), annular calcification, or tumor. Accordingly, the term ischemic MR should be restricted to chronic MR, occurring more than 2 weeks after MI and in the absence of structural MV disease. From a pathogenic point of view, it is a manifestation of postinfarction ventricular remodeling. The size, location, and transmurality of the MI sets in motion left ventricle (LV) remodeling that determines the severity, time course, and clinical manifestation of ischemic MR. The presentation develops insidiously over time in association with congestive heart failure.
Keywords
- Mitral Regurgitation
- Cardiac Resynchronization Therapy
- Posterior Leaflet
- Ischemic Mitral Regurgitation
- Regurgitant Volume
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Maisel AS, Gilpin EA, Klein L, Le Winter M, Henning H, Collins D. The murmur of papillary muscle dysfunction in acute myocardial infarction; clinical features and prognostic implications. Am Heart J. 1986;112:705-711.
Barzilai B, Gessler C Jr, Pérez JE, Schaab C, Jaffe AS. Significance of Doppler-detected mitral regurgitation in acute myocardial infarction. Am J Cardiol. 1988;61:220-223.
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;117:10-17.
Loperfido Loperfido F, Biasucci LM, Pennestri F, et al. Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction. Am J Cardiol. 1986;58:692-697.
Tcheng JE, Jackman JD Jr, Nelson CL, et al. Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. Ann Intern Med. 1992;117:18-24.
Hickey MS, Smith LR, Muhlbaier LH, et al. Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation. 1989;798:I51-I59.
Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik J. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001;103:1759-1764.
He S, Fontaine AA, Schwammenthal E, Yoganathan AP, Levine RA. Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies. Circulation. 1997;96:1826-1834.
Roberts WC, Cohen LS. Left ventricular papillary muscles. Description of the normal and a survey of conditions causing them to be abnormal. Circulation. 1972;46:138-154.
Sharma SK, Seckler J, Israel DH, Borrico S, Ambrose JA. Clinical, angiographic and anatomic findings in acute severe ischemic mitral regurgitation. Am J Cardiol. 1992;70:277-280.
Hendren WG, Nemec JJ, Lytle BW, et al. Mitral valve repair for ischemic mitral insufficiency. Ann Thorac Surg. 1991;52:1246-1251.
Rankin JS, Feneley MP, Hickey MS, et al. A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 1988;95:165-177.
Kaul S, Spotnitz WD, Glasheen WP, Touchstone DA. Mechanism of ischemic mitral regurgitation. An experimental evaluation. Circulation. 1991;84:2167-2180.
Levine RA, Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005;112:745-758.
Tenenbaum A, Leor J, Motro M, et al. Improved posterobasal segment function after thrombolysis is associated with decreased incidence of significant mitral regurgitation in a first inferior myocardial infarction. J Am Coll Cardiol. 1995;25:1558-1563.
Aklog L, Filsoufi F, Flores KQ, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation. 2001;104:I68-I75.
Breithardt OA, Sinha AM, Schwammenthal E, et al. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol. 2003;41:765-770.
Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LE, Gorscan J 3rd. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping. J Am Coll Cardiol. 2004;44:1619-1625.
Levine HJ, Gaasch WH. Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves. J Am Coll Cardiol. 1996;28:1083-1091.
Heinle SK, Tice FD, Kisslo J. Effect of dobutamine stress echocardiography on mitral regurgitation. J Am Coll Cardiol. 1994;25:122-127.
Kizilbash AM, Willett DL, Brickner ME, Heinle SK, Grayburn PA. Effects of afterload reduction on vena contracta width in mitral regurgitation. J Am Coll Cardiol. 1998;32:427-431.
Godley RW, Wann LS, Rogers EW, Feigenbaum H, Weyman AE. Incomplete mitral leaflet closure in patients with papillary muscle dysfunction. Circulation. 1981;63:565-571.
Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction. A quantitative clinical study. Circulation. 2000;102:1400-1406.
Agricola E, Oppizzi M, Maisano F, et al. Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern. Eur J Echocardiogr. 2004;5:326-334.
Agricola E, Oppizzi M, Pisani M, Meris A, Maisano F, Margonato A. Ischemic mitral regurgitation: mechanisms and echocardiographic classification. Eur J Echocardiogr. 2007;9:207-221.
Messas E, Guerrero JL, Handschumacher MD, et al. Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation. Circulation. 2001;104:1958-1963.
Salgo IS, Gorman JH 3rd, Gorman RC, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation. 2002;106:711-717.
Watanabe N, Ogasawara Y, Yamaura Y, et al. Mitral annulus flattens in ischemic mitral regurgitation: geometric differences between inferior and anterior myocardial infarction: a realtime 3-dimensional echocardiographic study. Circulation. 2005;112:I458-I1462.
Ahmad RM, Gillinov AM, McCarthy PM, Blackstone EH, et al. Annular geometry and motion in human ischemic mitral regurgitation: novel assessment with three-dimensional echocardiography and computer reconstruction. Ann Thorac Surg. 2004;78:2063-2068.
De Simone R, Wolf I, Mottl-Link S, et al. A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty. Eur J Cardiothorac Surg. 2006;29:355-361.
Otsuji Y, Kumanohoso T, Yoshifuku S, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol. 2002;39:1651-1656.
He S, Lemmon JD Jr, Weston MW, Jensen MO, Levine RA, Yoganathan AP. Mitral valve compensation for annular dilatation: in vitro study into the mechanisms of functional mitral regurgitation with an adjustable annulus model. J Heart Valve Dis. 1999;8:294-302.
Lapu-Bula R, Robert A, Vancrayenest D, et al. Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with dilated cardiomyopathy. Circulation. 2002;106:1342-1348.
Lancellotti P, Lebrun F, Pierard LA. Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol. 2003;42:1921-1928.
Zoghbi WA, Enriquez-Sarano M, Foster E, et al. American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777-802.
Matsumura Y, Fukuda S, Tran H, et al. Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: difference between functional mitral regurgitation and prolapse regurgitation. Am Heart J. 2008;155:231-238.
Matsumura Y, Saracino G, Sugioka K, et al. Determination of regurgitant orifice area with the use of a new three-dimensional flow convergence geometric assumption in functional mitral regurgitation. J Am Soc Echocardiogr. 2008;21:1251-1256.
Schwammenthal E, Chen C, Benning F, Block M, Breithardt G, Levine RA. Dynamics of mitral regurgitant flow and orifice area. Physiologic application of the proximal flow convergence method: clinical data and experimental testing. Circulation. 1994;90:307-322.
Buck T, Plicht B, Kahlert P, Schenk IM, Hunold P, Erbel R. Effect of dynamic flow rate and orifice area on mitral regurgitant stroke volume quantification using the proximal isovelocity surface area method. J Am Coll Cardiol. 2008;52: 767-778.
Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, Sénéchal M. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation. 2007;115: 782-791.
Watanabe N, Ogasawara Y, Yamaura Y, et al. Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography. J Am Coll Cardiol. 2005;45:763-769.
Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation. 2003;108:1713-1717.
Vanoverschelde J-L, Pasquet A, Gerber BL, Melin LA. Principles of myocardial viability. Implications for echocardiography. In: Kisslo J, Nihoyannopoulos P, eds. Echocardiography. London: Springer; 2009:351-365.
de Waroux JB Le Polain, Pouleur AC, Vancraeynest D, et al. Early hazards of mitral ring annuloplasty in patients with moderate to severe ischemic mitral regurgitation undergoing coronary revascularization: the importance of preoperative myocardial viability. J Heart Valve Dis. 2009;18:35-43.
Penicka M, Linkova H, Lang O, et al. Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery. Circulation. 2009;120:1474-1481.
Flynn M, Curtin R, Nowicki ER, et al. Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study. J Thorac Cardiovasc Surg. 2009;137: 1063-1070.
Stevenson LW, Bellil D, Grover-McKay M, et al. Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1987;60:654-658.
Levine AB, Muller C, Levine TB. Effects of high-dose lisinopril-isosorbide dinitrate on severe mitral regurgitation and heart failure remodeling. Am J Cardiol. 1998;82:1299-1301.
Bonet S, Agusti A, Arnau JM, et al. Beta-adrenergic blocking agents in heart failure: benefits of vasodilating and non-vasodilating agents according to patients’ characteristics: a meta-analysis of clinical trials. Arch Intern Med. 2000;160: 621-627.
Lowes BD, Gill EA, Abraham WT, et al. Effects of carvedilol on left ventricular mass, chamber geometry, and mitral regurgitation in chronic heart failure. Am J Cardiol. 1999;83: 1201-1205.
Capomolla S, Febo O, Gnemmi M, et al. Beta-blockade therapy in chronic heart failure: diastolic function and mitral regurgitation improvement by carvedilol. Am Heart J. 2000;139:596-608.
Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg. 1998;115:381-386.
Bax JJ, Braun J, Somer ST, et al. Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation. 2004;110:II103-II108.
Braun J, Bax JJ, Versteegh MI, et al. Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation. Eur J Cardiothorac Surg. 2005;27:847-853.
Hung J, Papakostas L, Tahta SA, et al. Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target. Circulation. 2004;110:II85-II90.
Ereminiene E, Vaskelyte J, Benetis R, Stoskute N. Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling. Echocardiography. 2005;22: 217-224.
Kongsaerepong V, Shiota M, Gillinov AM, et al. Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation. Am J Cardiol. 2006;98:504-508.
De Bonis M, Lapenna E, La Canna G, et al. Mitral valve repair for functional mitral regurgitation in end-stage dilated cardiomyopathy: role of the “edge-to-edge” technique. Circulation. 2005;112:I402-I408.
Akins CW, Hilgenberg AD, Buckley MJ, et al. Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg. 1994;58: 668-675.
Gillinov AM, Wierup PN, Blackstone EH, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2001;122:1125-1141.
Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230-268.
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Vanoverschelde, JL., El Khoury, G., Pasquet, A. (2010). Chronic 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_4
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