Ischemic mitral regurgitation

Abstract

Ischemic mitral regurgitation (IMR) is present in 10%-20% of patients with Coronary Artery Disease (CAD) and is associated with a markedly worse prognosis and long-term patient survival in comparison with other types of mitral regurgitation. IMR can be classified into an acute type and a chronic type. Acute IMR occurs as a result of papillary muscle rupture complicating acute myocardial infarction or as a result of acute ischemic episodes involving the Left circumflex or right coronary Artery, resulting in 'Flash pulmonary edema'. Chronic IMR is primarily a ventricular problem, not a valvular problem, caused by LV remodeling resulting from ischemic cardiomyopathy. Chronic IMR is characterizes by a dynamic nature that may affect the degree of regurgitation and is related to several factor, including LV function and loading conditions. The majority of patients with chronic IMR is asymptomatic and may be incidentally discovered during evaluation for myocardial revasculari-zation. Less commonly, those patients may present with progressive heart failure when MR is moderate to severe. Transthoracic /Transesophageal Echocardiography represents the gold standard for evaluation if IMR. It has been used to establish the diagnosis of IMR as well as to quantify the degree of regurgitation and to identify the underlying mechanism of valve dysfunction to guide any possible therapy. Cardiac MRI has recently emerged as single-pass diagnostic tool that allows evaluation of valvular/ subvalvular and LV geometry, along with myocardial viability, which has recently been shown to be predictive of post-revascularization outcome on IMR. Ischemic Mitral Regurgitation (IMR) continues to be a per-plexing clinical problem and controversy continues with regards to optimal therapeutic modality. We review in this chapter different diagnostic and therapeutic modalities for chronic IMR with emphasis on the decision making process supported by up to date review of the available evidence. © 2012 by Nova Science Publishers, Inc. All rights reserved.