Ischemic mitral valve prolapse

Abstract

Ischemic mitral prolapse (IMP) is a pathologic entity encountered in about one-third amongthe patients undergoing surgery for ischemic mitral regurgitation (IMR). IMP is generally the result of apapillary muscle injury consequent to myocardial, but the recent literature is progressively unveiling a morecomplex pathogenesis. The mechanisms underlying its development regards the impairment of one or morecomponents of the mitral apparatus, which comprises the annulus, the chordae tendineae, the papillarymuscle and the left ventricular wall. IMP is not only a disorder of valvular function, but also entails coexistentaspects of a geometric disturbance of the mitral valve configuration and of the left ventricular functionand dimension and a correct understanding of all these aspects is crucial to guide and tailor the correcttherapeutic strategy to be adopted. Localization of prolapse, anatomic features of the prolapsed leaflets andthe subvalvular apparatus should be carefully evaluated as also constituting the major determinants definingpatient's outcomes. This review will summarize our current understanding of the pathophysiology andclinical evidence on IMP with a particular focus on the surgical treatment.