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Post Ischemic Mitral Regurgitation

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Essentials of Operative Cardiac Surgery

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Abstract

Objectives: Myocardial infarction is one of the leading causes of death worldwide. Beyond the acute mechanical complications, it is clear the pathophysiological evolution that affects the left ventricle which in some cases generates a “new valvulopathy” of the mitral valve. We will focus on secondary, post ischemic mitral insufficiency with particular attention to surgical indications and the new repair techniques. Methods: In this chapter the triggering factors and physiopsathological mechanisms that characterize the onset of mitral valve insufficiency will be analyzed. In addition, the surgical indications for the best treatment of mitral valve insufficiency according to international guidelines will be presented. Results: Our work has shown the importance of understanding the pathophysiological mechanism in order to perform the repair of mitral valve disease in the best possible way, highlighting the most modern and recent techniques of mitral valve repair using subanular techniques. Conclusions: Having established the pathophysiological mechanism well and applying the most suitable mitral repair techniques, it is now possible to perform a correct and lasting repair of the mitral valve by means of subanular techniques as regards post ischemic mitral valve disease.

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Abbreviations

aPPM::

Papillary muscles approximation

CABG::

Coronary artery bypass grafting

IMR::

Ischemic mitral regurgitation

LV::

Left Ventricular

LVEF::

Left ventricular eiection fraction

rPPM::

Papillary muscle relocaction

References

  1. Ishikawa M, Watanabe S, Hammoudi N, Aguero J, Bikou O, Fish K, Hajjar RJ. Reduced longitudinal contraction is associated with ischemic mitral regurgitation after posterior. Am J Physiol Heart Circ Physiol. 2018 Feb 1;314(2):H322–9. https://doi.org/10.1152/ajpheart.00546.2017.

    Article  CAS  Google Scholar 

  2. Nkomo VT, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11.

    Article  Google Scholar 

  3. Enriquez-Sarano M, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352:875–83.

    Article  CAS  Google Scholar 

  4. Apostolidou E, Maslow AD, Poppas A. Primary mitral valve regurgitation: update and review. Glob Cardiol Sci Pract. 2017;2017(1):e201703. https://doi.org/10.21542/gcsp.2017.3.

    Article  Google Scholar 

  5. Otto CM. Textbook of clinical echocardiography. 4th ed. Saunders; 2009. p. 311–2.

    Google Scholar 

  6. Enriquez-Sarano M, Freeman W, et al. Functional anatomy of mitral regurgitation: echocardiographic assessment and implications on outcome. J Am Coll Cardiol. 1999;34:1129–36.

    Article  CAS  Google Scholar 

  7. Olson LJ, Subramanian R, et al. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc. 1987;62:22–34.

    Article  CAS  Google Scholar 

  8. Griffin BP. Myxomatous mitral valve disease: Valvular heart disease- a companion to Braunwald’s heart disease. Philadelphia: Saunders/Elsevier; 2009. p. 243–9.

    Book  Google Scholar 

  9. Remenyi B, ElGuindy A, et al. Valvular heart disease 3: Valvular aspects of rheumatic heart disease. Lancet. 2016;387:1335–46.

    Article  Google Scholar 

  10. Brand MD, Abadi CA, et al. Radiation- associated valvular heart disease in Hodgkin’s disease is associated with characteristic thickening and fibrosis of the aortic- mitral curtain. J Heart Valve Dis. 2001;10(5):681–5.

    CAS  Google Scholar 

  11. Bursi F, Enriquez-Sarano M, et al. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation. 2005;111(3):295–301.

    Article  Google Scholar 

  12. Birsi F, Enriquez-Sarano M, et al. Mitral regurgitation after myocardial infarction: a review. Am J Med. 2006;119:103–12.

    Article  Google Scholar 

  13. Nappi F, Singh SSA, Padala M, Attias D, Nejjari M, Mihos CG, Benedetto U, Michler R. The choice of treatment in ischemic mitral regurgitation with reduced left ventricular function. Ann Thorac Surg. Author manuscript; available in PMC 2020 Aug 13. Published in final edited form as:. Ann Thorac Surg. 2019;108(6):1901–12.

    Article  Google Scholar 

  14. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, et al. 2008 focused update incorporated in to the ACC/AHA 2006 guidelines for the Management of Patients with Valvular Heart Disease. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1998 guidelines for the Management of Patients with Valvular Heart Disease). Circulation. 2008;118:e523–661.

    Google Scholar 

  15. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baròn-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). The joint task force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012(33):2451–96.

    Google Scholar 

  16. Fattouch K, Guccione F, Sampognaro R, et al. Efficacy of adding mitral valve restrictive annuloplasty to CABG in patients with moderate ischemic mitral valve regurgitation: a randomised trial. J Thorac Cardiovasc Surg. 2009;138:278–85.

    Article  Google Scholar 

  17. Gillinov AM, Wierup PN, Blackstone EH, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2001;122:1125–41.

    Article  CAS  Google Scholar 

  18. Vassileva CM, Boley T, Markwell S, Hazelrigg S. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation. Eur J Cardiothoracic Surg. 2011;39:295–303.

    Article  Google Scholar 

  19. Kuwahara E, Otsuji Y, Iguro, et al. Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in chronic phase after surgical Annuloplasty: importance of augmented posterior leaflet tethering. Circulation. 2006;114:I-529–34.

    Article  Google Scholar 

  20. Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve Annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. JACC. 2007;49:2191–201.

    Article  Google Scholar 

  21. Kron IL, Green GR, Cope JT. Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg. 2002;74:600–1.

    Article  Google Scholar 

  22. Wagner CE, Irving L. Kron Subvalvular techniques to optimize surgical repair of ischemic regurgitation Curr Opin Cardiol. Author manuscript; available in PMC 2014 Jun 9. Published in final edited form as. Curr Opin Cardiol. 2014 Mar;29(2):140–4.

    Article  Google Scholar 

  23. Chang B-C, Youn Y-N, Ha J-W, Lim S-H, Hong Y-S, Chung N. Long-term clinical results of mitral valvuloplasty using flexible and rigid rings: a prospective and randomized study. J Thorac Cardiovasc Surg. 2007;133:995–1003. https://doi.org/10.1016/j.jtcvs.2006.10.023.

    Article  Google Scholar 

  24. Micali LR, Qadrouh MN, Parise O, Parise G, Matteucci F, de Jong M, Tetta C, Moula AI, Johnson DM, Gelsomino S. Papillary muscle intervention vs mitral ring annuloplasty in ichemic mitral regurgitation. J Card Surg. 2020;35(3):645–53. https://doi.org/10.1111/jocs.14407.

    Article  Google Scholar 

  25. Messas E, Bel A, Szymanski C, Cohen I, Touchot B, Handschumacher MD, Desnos M, Carpentier A, Menasché P, Hagège AA, Levine RA. Relief of mitral leaflet tethering following chronic myocardial infarction by chordal cutting diminishes left ventricular remodeling. Circ Cardiovasc Imaging. 2010 Nov;3(6):679–86. https://doi.org/10.1161/CIRCIMAGING.109.931840.

    Article  Google Scholar 

  26. Jensen H, Jensen MO, Smerup MH, et al. Impact of papillary muscle relocation as adjunct procedure to mitral ring annuloplasty in functional ischemic mitral regurgitation. Circulation. 2009 Sep 15;120(11 Suppl):S92–8.

    Google Scholar 

  27. Fattouch K, Castrovinci S, Murana G, et al. Papillary muscles relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results. J Thorac Cardiovasc Surg. 2014;

    Google Scholar 

  28. Szymanski C, Bel A, Cohen I, et al. Comprehensive annular and subvalvular repair of chronicischemic mitral regurgitation improves long-term results with the least ventricular remodeling. Circulation. 2012;126:2720–7. This study showed that concomitant bileaflet secondary chordal cutting results in decreased severity of recurrent mitral regurgitation and is associated with reversal of remodeling without an adverse impact on left ventricular function

    Article  Google Scholar 

  29. Messas E, Guerrero JL, Handschumacher MD, et al. Chordal cutting a new therapeutic approach for ischemic mitral regurgitation. Circulation. 2001;104:1958.

    Article  CAS  Google Scholar 

  30. Szymanski C, Bel A, Cohen I, et al. Comprehensive annular and subvalvular repair of chronic ischemic mitral regurgitation improves long-term results with the least ventricular remodeling. Circulation. 2012 Dec 4;126(23):2720–7.

    Article  Google Scholar 

  31. Cappabianca G, Bichi S, Patrini D, et al. Cut-and-transfer technique for ischemic mitral regurgitation and severe tethering of mitral leaflets. Ann Thorac Surg. 2013;96:1607–13.

    Article  Google Scholar 

  32. Hvass U, Tapia M, Baron F, et al. Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation. Ann Thorac Surg. 2003;75:809–11.

    Article  Google Scholar 

  33. Ishikawa S, Ueda K, Kawasaki A, et al. Papillary muscle sandwich plasty for ischemic mitral regurgitation: a new simple technique. J Thorac Cardiovasc Surg. 2008;135:1384–6.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Papardo Hospital, Messina, Italy

    Alessio Giuseppe Vite

  2. Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England, UK

    Panagiotis G. Kyriazis

  3. National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, England, UK

    Panagiotis G. Kyriazis

  4. Anthea Hospital, Bari, Italy

    Marco Moscarelli

Authors
  1. Alessio Giuseppe Vite
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  2. Panagiotis G. Kyriazis
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  3. Marco Moscarelli
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Editor information

Editors and Affiliations

  1. National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, England, UK

    Prakash P. Punjabi

  2. National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, England, UK

    Panagiotis G. Kyriazis

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Vite, A.G., Kyriazis, P.G., Moscarelli, M. (2022). Post Ischemic Mitral Regurgitation. In: Punjabi, P.P., Kyriazis, P.G. (eds) Essentials of Operative Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-14557-5_10

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  • DOI: https://doi.org/10.1007/978-3-031-14557-5_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14556-8

  • Online ISBN: 978-3-031-14557-5

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