[Mitral regurgitation following myocardial infarction (author's transl)]

Incompetence of the mitral valve may occur within days or weeks following myocardial infarction. The etiology most often encountered is rupture of a papillary muscle or one or more chordae tendineae. Since echocardiography is available, dysfunction of the papillary muscle with resulting incompetence of the valve is diagnosed more frequently. The mortality of the disease without surgical correction is reported as high as 95% within the first 3 months following the development of a murmur. The results of the surgical therapy are closely related to the time interval between myocardial infarction and time of surgery. Twenty-one (46%) of 45 patients with acute mitral regurgitation following myocardial infarction and cardiogenic shock operated upon at the Pacific Medical Center died during the early postoperative period. Mortality was extremely high with 78% when surgery had to be done within the first weeks following the acute myocardial infarction. Surgery within 2 to 3 months following the myocardial infarction carried a mortality of 44%, whereas only 6 of 22 patients operated upon more than 3 months after the acute infarction died. The high mortality of the natural course of the disease should be encouragement to think of the possibility of surgical correction of the valvular disease, especially when optimal medical treatment including medical and mechanical inotropic support have failed. Advances in cardial surgery, such as myocardial protection as well as postoperative care, may result in further improvement of the results.