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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Ischemic mitral regurgitation: problem extent in cardiovascular surgery clinic
Sergiy A Rudenko1, Sergiy V Potashev1, Anatoliy V Rudenko1
1Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
Wiadomosci Lekarskie (Warsaw, Poland : 1960)
|March 4, 2020
Summary
Mitral regurgitation (MR) is common in coronary artery disease (CAD), but most cases are mild and require no intervention. Severe MR, often ischemic (IMR), is rare but necessitates surgical repair.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) frequently coexists with mitral regurgitation (MR).
- Understanding the prevalence and characteristics of MR in CAD patients is crucial for guiding treatment strategies.
- Ischemic mitral regurgitation (IMR) is a significant complication in CAD, impacting patient outcomes.
Purpose of the Study:
- To evaluate the prevalence, etiology, mechanisms, and severity of all MR cases, including IMR, in patients with suspected or confirmed CAD.
- To assess the role of echocardiographic parameters in quantifying MR severity and guiding management decisions.
Main Methods:
- Prospective study of 370 patients with suspected or verified CAD.
- Transthoracic echocardiography (TTE) was used to assess MR type, severity (vena contracta width, ERO, RVol), and associated cardiac remodeling.
- Additional parameters included left atrium (LA) and left ventricle (LV) dimensions, diastolic filling, pulmonary vein flow, and right heart involvement.
Main Results:
- MR was found in up to half of CAD patients, with no significant gender difference.
- The majority (84.1%) of MR cases were mild (Grade I) and did not require surgical intervention.
- Moderate-to-severe MR, predominantly IMR, was associated with LV remodeling and often required revascularization and/or mitral valve intervention.
- Effective regurgitant orifice (ERO) and regurgitant volume (RVol) correlated well with cardiac remodeling indices.
Conclusions:
- IMR is a frequent finding in CAD, but mild MR is most common and usually requires no intervention.
- Severe MR is rare (<10%) in CAD patients but always necessitates surgical repair.
- Moderate-to-severe IMR is the primary cause of significant MR in CAD, requiring close TTE monitoring for optimal intervention timing.
- ERO and RVol are reliable quantitative indices for assessing MR severity and guiding surgical decisions in CAD patients.
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