Ischemic mitral regurgitation (IMR) has a profound negative effect on survival of patients following myocardial infarction. It occurs when the closing forces are overpowered by the tethering forces as a consequence of ventricular remodeling. Surgeons sought to correct moderate and severe IMR by mitral annuloplasty. Though short-term results were encouraging, survival after 2 years were not so. Higher recurrence rates were also noted with severe mitral regurgitation (MR). Parameters defining severity of IMR were initially formulated in 2003. These were revised enabling intervention in moderate MR in 2014. With the lack of positive medium and long-term evidence, 2017 guidelines have raised the bar, discouraging intervention in moderate IMR. Current guidelines have taken a conservative stance in advocating repair only for severe MR and very symptomatic patients. Till emergence of fresh evidence surgical enthusiasm for repair of IMR has to be restrained.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Chan KM, Amirak E, Zakkar M, Flather M, Pepper JR, Punjabi PP. Ischemic mitral regurgitation: in search of best treatment for a common condition. Prog Cardiovasc Dis. 2009;51:460–71.
Pastorius CA, Henry TD, Harris KM. Long-term outcomes of patients with mitral regurgitation undergoing percutaneous coronary intervention. Am J Cardiol. 2007;100:1218–23.
Levine RA, Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005;112:745–58.
Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14:611–44.
Azpitarte J, Alonso AM, Garcio Gallego F, González Santos JM, Paré C, Tello A. Guidelines of the Spanish Society of Cardiology on valve heart disease. Rev Esp Cardiol. 2000;53:1209–78.
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;108:1713–7.
Zeng X, Levine RA, Hua L, et al. Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography. Circ Cardiovasc Imaging. 2011;4:506–13.
Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777–802.
Chan KM, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation. 2012;126:2502–10.
Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task force on Clinical Practice guidelines. Circulation. 2017;135:e1159–95.
Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 2016;374:1932–41.
Virk SA, Tian DH, Sriravindrarajah A, et al. Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: meta-analysis of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg. 2017;154:127–36.
Acker MA, Parides MK, Perrault LP, et al. Mitral -valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370:23–32.
Özkan M. What is new in ACC/AHA 2017 focused updateof valvular heart disease guidelines. Anatol J Cardiol. 2017;17:421–2.
Varma PK, Krishna N, Jose RL, Madkaiker AN. Ischemic mitral regurgitation. Ann Card Anaesth. 2017;20:432–9.
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical approval has been noted and complied with.
Not applicable as this is a review article.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Sarkar, K., Patra, S. Ischemic mitral regurgitation: the way ahead is a step back . Indian J Thorac Cardiovasc Surg (2020). https://doi.org/10.1007/s12055-019-00903-1
- Mitral regurgitation