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Ischemic mitral regurgitation: current understanding and surgical options

  • Alexander Angelo BresciaEmail author
  • Tessa Maria Fontana Watt
  • Steven Frederic Bolling
Review Article
  • 14 Downloads

Abstract

Secondary, or functional, mitral regurgitation (MR) occurs with impaired coaptation of structurally normal valve leaflets due to abnormal structure and/or function of the left ventricle (LV). A leading cause of functional mitral regurgitation is ischemic cardiomyopathy, resulting in left ventricular dysfunction and subsequent congestive heart failure (CHF) and ischemic mitral regurgitation (IMR). The value of surgical or transcatheter correction of IMR remains controversial, since the underlying pathology of IMR is attributed to a dysfunctional left ventricle. However, even mild IMR has been shown to be harmful to CHF patients, as IMR is both a surrogate of advanced CHF and an independent contributor to CHF morbidity and mortality. While observational and randomized studies have examined surgical treatment of IMR with conflicting outcomes, additional well-designed randomized controlled trials should be performed to further clarify the optimal treatment for IMR. Additionally, close attention should be paid to the quality of interventions performed, as durable reduction in IMR provides the best hope of a positive clinical outcome. This review focuses on the pathophysiology of IMR, current evidence regarding surgical and transcatheter interventions, and future directions in management of IMR.

Keywords

Functional mitral regurgitation Ischemic mitral regurgitation Mitral valve repair 

Notes

Funding information

Alexander Brescia is supported by the National Institutes of Health National Research Service Award postdoctoral fellowship (No. 5T32HL076123).

Compliance with ethical standards

Human and animal rights

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Not applicable.

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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2019

Authors and Affiliations

  1. 1.Department of Cardiac Surgery, Frankel Cardiovascular CenterUniversity of MichiganAnn ArborUSA

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