MITRAL VALVE INTERVENTIONS IN SEVERE ISCHEMIC MITRAL REGURGITATION (MITRAL VALVE REPAIR VERSUS REPLACEMENT)

Abstract

Ischemic mitral regurgitation is a serious consequence of coronary artery disease, in particular myocardial infarction, that carries a substantial risk of death from cardiovascular causes in proportion to its severity.(1) Ischemic mitral regurgitation refers to regurgitation that results not because of a structural abnormality through the mitral valve, but rather due to a distortion of the subvalvular apparatus by enlargement and remodeling of the infracted left ventricle resulting in mitral regurgitation by, reducing the closing forces of the valve due to left ventricular dysfunction (hypokinetic areas and dyssynchrony), tethering of the leaflets due to apical and lateral displacement of the papillary muscles, and annular dilatation. Importantly, it is a dynamic condition, the severity of which can vary with loading conditions. (2) About one-fifth of patients, post myocardial infarction are complicated by mitral regurgitation, and more frequently inferior myocardial infarction, rather than antero-septal infarction. (3) Ischemic mitral regurgitation is associated with a critical obstruction (> 70%) of at least one main coronary vessel; it is most commonly seen in ischemic cardiomyopathies. (4)