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Current management of ischemic mitral regurgitation
Farzan Filsoufi1, Sacha P Salzberg, David H Adams
1Department of Cardiothoracic Surgery, Box 1028, Mount Sinai Medical Center, 1 East 100th Street, New York, NY 10029, USA. Farzan.Filsoufi@mountsinai.org
The Mount Sinai Journal of Medicine, New York
|March 17, 2005
Summary
Ischemic mitral regurgitation (IMR) complicates severe coronary artery disease and myocardial infarction. Surgical correction, often during coronary revascularization, is increasingly common due to IMR's negative impact on survival.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Valve Disease
Background:
- Ischemic mitral regurgitation (IMR) is a complication of severe coronary artery disease and myocardial infarction.
- It arises from left ventricular remodeling post-myocardial infarction and can occur during acute ischemia.
- IMR negatively impacts long-term patient survival.
Purpose of the Study:
- To define ischemic mitral regurgitation (IMR).
- To review the pathophysiology, clinical presentation, diagnosis, and surgical indications for IMR.
- To discuss the management of IMR.
Main Methods:
- Literature review of pathophysiology, clinical presentation, diagnosis, and management of IMR.
- Focus on Carpentier's type IIIb dysfunction as the most common IMR mechanism.
- Discussion of undersized remodeling annuloplasty as the preferred surgical treatment.
Main Results:
- IMR is a significant complication associated with adverse long-term outcomes.
- Carpentier's type IIIb dysfunction is the predominant mechanism.
- Undersized remodeling annuloplasty is the recommended surgical approach.
Conclusions:
- Increased awareness of IMR's pathophysiology and survival impact drives surgical referrals.
- Timely diagnosis and appropriate surgical intervention are crucial for managing IMR.
- Surgical correction of IMR, particularly during coronary revascularization, improves patient outcomes.