[Moderate ischemic mitral regurgitation: to operate or to ignore?]

Moderate ischemic mitral regurgitation (MR) is characterized by significant, symptomatic multivessel coronary disease and mitral regurgitation 2-3+.

A 60-year-old patient was admitted at the Cardiovascular Institute "Dedinje" due to the symptoms of unstable angina pectoris. He survived a myocardial infarction (inferoposterolateral localization) 8 years ago. On admission echocardiogram revealed regional disturbances of the left ventricle wall with ejection fraction of 25% and mitral regurgitation 2+. The patient underwent a triple coronary bypass with surgical correction of mitral regurgitation. Postoperative course was normal.

Several authors are against surgical correction of MR in moderate ischemic MR due to several reasons: revascularization of ischemic areas will improve regional wall motion and correct MR, while mitral valve surgery adds significantly to the operative risk of coronary surgery. Other authors, however, favour combined operation emphasizing that in many patients coronary surgery alone will not correct a moderate ischemic MR. Today there is no consensus whether to operate the moderate ischemic MR or to ignore it. Some novel studies underscore significant predictors of a long-term survival of these patients: NYHA (New York Heart Association) class and left ventricle ejection fraction. In that respect a combined operation should be recommended in patients with heart failure and NYHA class III and IV.