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[Two cases of severe ischemic mitral regurgitation treated with CABG alone]
1Department of Cardiovascular Surgery, Kinan General Hospital.
Insights
Severe ischemic mitral regurgitation (MR) can cause pulmonary edema after cardiac procedures. Coronary artery bypass grafting (CABG) effectively treated this condition in two patients, highlighting the importance of comprehensive MR evaluation.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Ischemic mitral regurgitation (MR) is a complication that can arise after myocardial infarction.
- Cardiac catheterization can precipitate acute events in patients with underlying heart conditions.
Observation:
- Two patients presented with pulmonary edema secondary to ischemic MR post-cardiac catheterization.
- Initial hospitalization echocardiography did not reveal significant MR, but left ventriculography showed severe MR.
Findings:
- Coronary angiography revealed triple vessel disease in both patients.
- Emergency coronary artery bypass grafting (CABG) with intra-aortic balloon pumping was performed.
- Postoperative assessments showed a decrease in MR severity.
Implications:
- Severe ischemic MR, even if not apparent on initial echocardiography, requires consideration.
- Coronary artery bypass grafting (CABG) may be sufficient treatment for severe ischemic MR.
- Comprehensive evaluation of ischemic MR using both left ventriculography and echocardiography is crucial.
Abstract:
We report here two cases in which patients fell into pulmonary edema due to ischemic mitral regurgitation (ischemic MR) after cardiac catheterization and underwent emergency coronary artery bypass grafting (CABG) using an intra-aortic balloon pumping. The patient were a 65-year-old man and a 80-year-old woman, and both had a chief complaint of angina after myocardiac infarction. In both cases, coronary angiography revealed triple vessel disease, and left ventriculography showed severe MR. However echocardiography, when they were hospitalized, did not show significant MR. Therefore we thought that they had gone into congestive heart failure because cardiac ischemia and volume load following cardiac catheterization provoked MR. In fact, postoperative left ventriculography and echocardiography showed decreased MR. We now think that it is important to keep in mind the cases of severe ischemic MR for which CABG alone is adequate treatment and to evaluate ischemic MR not only by left ventriculography but also by echocardiography.