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[Ischemic mitral valve insufficiency. Incidence, diagnosis and surgical treatment]
L A Dallan1, S A Oliveira, F Atik
1Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo.
Purpose:
To study the incidence of ischemic mitral regurgitation (MR) and the mortality.
Methods:
One-hundred-five cases of acute myocardial infarction (AMI) with MR were reviewed. Patients were divided in two groups: group A-59 (56.2%) necropsied patients without previous surgical procedures to correlate clinical pictures with the aim to determine the cause of death; group B-46 (43.8%) patients were submitted to surgical treatment. This group was subdivided in mild, moderate and severe forms of MR, and studied comparatively the type of surgical treatment and its evolution.
Results:
Group A-23 (39%) patients with mild forms and predominant ischemic heart disease, responsible for death; 18 (30.5%) patients without previous diagnosis, masked by myocardial failure and 18 (30.5%) with severe MR and coronary heart disease; group B-14 (30.4%) patients died at the immediate post-operatory period. Higher mortality associated to ejection fraction (EF) below 35% (47.6%; p = 0.022), severe MR (41.7%; p = 0.044) and cardiogenic shock (52.9%; p = 0.14). In 41 (89.1%), the mitral valve repair was combined to coronary artery bypass grafting operation (CABG), in 4 (8.7%) this last procedure was made without mitral repair and in the remaining patients the surgery was limited to the valve. Mitral valvuloplasty was performed in 23 (50%) patients with 3 (13%) deaths, and in 19 (42.3%) the mitral valve was replaced with 9 (47.4%) deaths.
Conclusion:
The prognosis is related to the grade of EF and to the severity of MR. In mild to moderate forms, the surgical indication is due to the associated coronary heart disease and the valvuloplasty is preferred, in this instance. In severe forms, surgical intervention must be performed as soon as possible, before cardiogenic shock appears.
Insights
Prognosis for ischemic mitral regurgitation (MR) depends on ejection fraction and MR severity. Surgical intervention, preferably valvuloplasty for mild-moderate MR, is crucial, especially before cardiogenic shock in severe cases.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Ischemic mitral regurgitation (MR) is a significant complication of acute myocardial infarction (AMI).
- Understanding the outcomes of medical management versus surgical intervention is critical for patient care.
Purpose of the Study:
- To investigate the incidence of ischemic MR and its associated mortality.
- To correlate clinical findings with outcomes in patients experiencing AMI and MR.
Main Methods:
- A retrospective review of 105 patients with AMI and MR.
- Patients were divided into two groups: necropsied (Group A, n=59) to determine causes of death and surgically treated (Group B, n=46).
- Group B was further stratified by MR severity (mild, moderate, severe) to compare surgical treatments and outcomes.
Main Results:
- In Group A, causes of death included ischemic heart disease (39%), undiagnosed MR (30.5%), and severe MR with coronary heart disease (30.5%).
- In Group B, mortality was higher with ejection fraction <35% (47.6%), severe MR (41.7%), and cardiogenic shock (52.9%).
- Mitral valve repair combined with coronary artery bypass grafting (CABG) was common (89.1%). Mitral valvuloplasty had lower mortality (13%) compared to valve replacement (47.4%).
Conclusions:
- Prognosis is significantly influenced by ejection fraction and MR severity.
- For mild to moderate MR associated with coronary heart disease, mitral valvuloplasty is the preferred surgical approach.
- Urgent surgical intervention is recommended for severe MR before the onset of cardiogenic shock.