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[Surgical treatment of ischemic mitral regurgitation]
M Hachida1, M Endo, Y Bonkohara
1Department of Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
Abstract:
Mitral regurgitation secondary to ischemic heart disease carries a significant mortality even after emergent open heart surgery. We report on 16 patients with mitral regurgitation associated with ischemic heart disease. The pathological findings were chorda elongation and papillary muscle dysfunction (PMD group) in 12 patients, and papillary muscle rupture (PR group in 4 patients. Preoperative characteristics were severe left ventricular failure in PMD group and high incidence of renal failure, in associated with high age in PR group. In PMD group, mitral plasty was performed in 10 patients out of 12 patients. In PR group all patients underwent mitral valve replacement. Thirteen patients underwent mitral surgery combined with coronary artery bypass grafting. No operative death was seen, one hospital death and 3 late deaths occurred. Three late deaths were seen in PMD group due to sudden death in 2 cases and arrhythmia in 1 case. One hospital death in PR group was due to multi-organ failure. We suggested incorporating these therapeutic concepts may introduce satisfactory results in surgical treatment for ischemic mitral regurgitation.
Insights
Surgical treatment for ischemic mitral regurgitation, a condition with high mortality, yielded satisfactory results. Therapeutic strategies incorporating mitral plasty or valve replacement, often with coronary artery bypass grafting, improved outcomes in patients with heart disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Valve Disease
Context:
- Ischemic heart disease frequently causes mitral regurgitation.
- This condition is associated with significant mortality, even after open-heart surgery.
- Understanding pathological subtypes is crucial for surgical planning.
Purpose:
- To report outcomes of surgical interventions for mitral regurgitation secondary to ischemic heart disease.
- To analyze differences in presentation and outcomes between mitral regurgitation subtypes: papillary muscle dysfunction (PMD) and papillary muscle rupture (PR).
Summary:
- This study reviewed 16 patients with ischemic mitral regurgitation, categorized into PMD (n=12) and PR (n=4) groups.
- PMD patients often had left ventricular failure; PR patients were older with renal failure.
- Surgical approaches included mitral plasty (PMD) and valve replacement (PR), frequently combined with coronary artery bypass grafting.
- No operative deaths occurred; one hospital death (PR group) and three late deaths (PMD group) were recorded.
Impact:
- Surgical management of ischemic mitral regurgitation, tailored to pathological findings, can achieve satisfactory results.
- Early identification and appropriate surgical intervention are key to improving survival rates.
- Further research into optimizing therapeutic strategies for these complex cases is warranted.