Ischemic Mitral Regurgitation: From Echo Assessment to Surgical Strategy and Techniques

Abstract

Ischemic mitral regurgitation remains an underestimated and important clinical problem. It is a complex multifactorial disease that involves global and regional left ventricular remodel‐ ing as well as dysfunction and distortion of the components of the mitral valve including the chordae, annulus and leaflets. The prevalence rate of development of mild or more severe degree of mitral insufficiency after myocardial infarction has been estimated to be up to 50% and is associated with worse prognosis (Stevenson 1987, Lamas 1997, Grigioni 2001). Based on the clinical presentation, the ischemic mitral regurgitation was classified as acute or chronic (Mitesh, 2009). Although the acute ischemic mitral regurgitation is relatively rare, whenever present, it has a rapid evolution, with an extremely poor survival rate. On the other hand, the chronic ischemic mitral regurgitation is much more frequent, but it’s the consequence of a slower pathological process, with a better survival rate. The echocardiography identifies all patterns of ischemic mitral regurgitation; nonetheless the classification as acute, sub-acute or chronic ischemic mitral regurgitation is rather clinical, than an echocardiographic one. Beside the complete rupture of papillary muscle, other patterns of ischemic mitral regurgita‐ tion cannot be practically located in time by echo. It is possible to have the same echocardio‐ graphic feature of the lesion in acute and in chronic settings; only the clinical presentation of the patient helps in the diagnosis of acute / sub-acute or chronic ischemic mitral regurgitation. So