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Ischemic mitral regurgitation: Recent advances

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This article reviews recent developments in the pathophysiology and management of ischemic mitral regurgitation. Recent imaging studies using three-dimensional echocardiography have added clarity to the mechanism responsible for this condition. This article also discusses recent studies on outcomes of surgical repair, including current results and potential risks of restrictive annuloplasty. Because of the limitations imposed by restrictive annuloplasty, adjunctive surgical methods focusing on the left ventricle or papillary muscles are being investigated to address this disease. In the interim, a downsized complete rigid or semirigid annuloplasty repair appears to offer good midterm outcomes.

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References and Recommended Reading

  1. Anyanwu A, Rahmanian PB, Filsoufi F, Adams DH: The pathophysiology of ischemic mitral regurgitation: implications for surgical and percutaneous intervention. J Interv Cardiol 2006, 19(5 Suppl):S78–S86.

    Article  Google Scholar 

  2. Carpentier A: Cardiac valve surgery-the “French correction.”; J Thorac Cardiovasc Surg 1983, 86:323–337.

    PubMed  CAS  Google Scholar 

  3. Adams DH, Anyanwu A: Pitfalls and limitations in measuring and interpreting the outcomes of mitral valve repair. J Thorac Cardiovasc Surg 2006, 131:523–529.

    Article  PubMed  Google Scholar 

  4. Ryan LP, Salgo IS, Gorman RC, Gorman JH 3rd: The emerging role of three-dimensional echocardiography in mitral valve repair. Semin Thorac Cardiovasc Surg 2006 18:126–134.

    Article  PubMed  Google Scholar 

  5. Ryan L, Jackson B, Parish L, et al.: Quantification and localization of mitral valve tenting in ischemic mitral regurgitation using real-time three-dimensional echocardiography. Eur J Cardiothorac Surg 2007, 31:839–834.

    Article  PubMed  Google Scholar 

  6. Watanabe N, Ogasawara Y, Yamaura Y, et al.: Geometric differences of the mitral valve tenting between anterior and inferior myocardial infarction with significant ischemic mitral regurgitation: quantitation by novel software system with transthoracic real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2006, 19:71–75.

    Article  PubMed  Google Scholar 

  7. Song JM, Qin JX, Kongsaerepong V, et al.: Determinants of ischemic mitral regurgitation in patients with chronic anterior wall myocardial infarction: a real time three-dimensional echocardiography study. Echocardiography 2006, 23:650–657.

    Article  PubMed  Google Scholar 

  8. Filsoufi F, Salzberg SP, Adams DH: Current management of ischemic mitral regurgitation. Mt Sinai J Med 2005, 72:105–115.

    PubMed  Google Scholar 

  9. Aronson D, Goldsher N, Zukermann R, et al.: Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med 2006, 166:2362–2368.

    Article  PubMed  Google Scholar 

  10. Grigioni F, Enriquez-Sarano M, Zehr KJ, et al.: Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 2001, 103:1759–1764.

    PubMed  CAS  Google Scholar 

  11. Pastorius CA, Henry TD, Harris KM: Long-term outcomes of patients with mitral regurgitation undergoing percutaneous coronary intervention. Am J Cardiol 2007, 100:1218–1223.

    Article  PubMed  Google Scholar 

  12. Ellis SG, Whitlow PL, Raymond RE, Schneider JP: Impact of mitral regurgitation on long-term survival after percutaneous coronary intervention. Am J Cardiol 2002, 89:315–318.

    Article  PubMed  Google Scholar 

  13. Crabtree TD, Bailey MS, Moon MR, et al.: Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation. Ann Thorac Surg 2008, 85:1537–1542.

    Article  PubMed  Google Scholar 

  14. Gelsomino S, Lorusso R, Capecchi I, et al.: Left ventricular reverse remodeling after undersized mitral ring annuloplasty in patients with ischemic regurgitation. Ann Thorac Surg 2008, 85:1319–1330.

    Article  PubMed  Google Scholar 

  15. Mihaljevic T, Lam BK, Rajeswaran J, et al.: Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol 2007, 49:2191–2201.

    Article  PubMed  Google Scholar 

  16. Braun J, van de Veire NR, Klautz RJ, et al.: Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg 2008, 85:430–436.

    Article  PubMed  Google Scholar 

  17. Gazoni LM, Kern JA, Swenson BR, et al.: A change in perspective: results for ischemic mitral valve repair are similar to mitral valve repair for degenerative disease. Ann Thorac Surg 2007, 84:750–757.

    Article  PubMed  Google Scholar 

  18. Levine RA, Schwammenthal E: Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation 2005, 112:745–758.

    Article  PubMed  Google Scholar 

  19. Borger MA, Murphy PM, Alam A, et al.: Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2007, 133:1483–1492.

    Article  PubMed  Google Scholar 

  20. Fayad G, Marechaux S, Modine T, et al.: Chordal cutting VIA aortotomy in ischemic mitral regurgitation: surgical and echocardiographic study. J Card Surg 2008, 23:52–77.

    Article  PubMed  Google Scholar 

  21. Hung J, Chaput M, Guerrero JL, et al.: Persistent reduction of ischemic mitral regurgitation by papillary muscle repositioning: structural stabilization of the papillary muscle-ventricular wall complex. Circulation 2007, 116(11 Suppl):I259–I263.

    PubMed  Google Scholar 

  22. Kron IL, Green GR, Cope JT: Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg 2002, 74:600–601.

    Article  PubMed  Google Scholar 

  23. Gillinov AM: Is ischemic mitral regurgitation an indication for surgical repair or replacement? Heart Fail Rev 2006, 11:231–239.

    Article  PubMed  Google Scholar 

  24. Ueno T, Sakata R, Iguro Y, et al.: Preoperative advanced left ventricular remodeling predisposes to recurrence of ischemic mitral regurgitation with less reverse remodeling. J Heart Valve Dis 2008, 17:36–41.

    PubMed  Google Scholar 

  25. Beeri R, Yosefy C, Guerrero JL, et al.: Early repair of moderate ischemic mitral regurgitation reverses left ventricular remodeling: a functional and molecular study. Circulation 2007, 116(11 Suppl):I288–I293.

    PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Magne J, Senechal M, Mathieu P, et al.: Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis. J Am Coll Cardiol 2008, 51:1692–1701.

    Article  PubMed  Google Scholar 

  28. Marwick TH: Restrictive annuloplasty for ischemic mitral regurgitation: too little or too much? J Am Coll Cardiol 2008, 51:1702–1703.

    Article  PubMed  Google Scholar 

  29. McGee EC, Gillinov AM, Blackstone EH, et al.: Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2004, 128:916–924.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Mount Sinai Hospital, 1190 Fifth Avenue, New York, NY, 10029, USA

    David H. Adams

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  1. Anelechi C. Anyanwu
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  2. David H. Adams
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Correspondence to David H. Adams.

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Anyanwu, A.C., Adams, D.H. Ischemic mitral regurgitation: Recent advances. Curr Treat Options Cardio Med 10, 529–537 (2008). https://doi.org/10.1007/s11936-008-0045-6

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  • DOI: https://doi.org/10.1007/s11936-008-0045-6

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