Ischemic Mitral Regurgitation and Its Related Risk After Myocardial Infarction

Salukhe, Tushar V.; Henein, Michael Y.; Sutton, Richard

doi:10.1161/01.cir.0000154574.46566.d5

Cited by 22 publications

(13 citation statements)

References 18 publications

(14 reference statements)

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“…119 With either technique, the surgical risk for ischemic mitral valve dysfunction is greater than that for nonischemic mitral valve disease. 120 Data developed at a few surgical referral centers have now demonstrated that mitral valve repair using a reduction annuloplasty procedure can be accomplished at low perioperative risk, even in patients with severe LV systolic dysfunction, and may result in substantial reverse remodeling, improved hemodynamics, and a reduction in symptoms. 121,122 A recent retrospective analysis of 682 consecutive patients with significant MR and LV systolic dysfunction (60% with ischemic origin), however, has not demonstrated a convincing survival benefit of this approach over the long term compared with medical therapy.…”

Section: Surgical Treatment Of Mrmentioning

confidence: 99%

Navigating the Crossroads of Coronary Artery Disease and Heart Failure

et al. 2006

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Section: Surgical Treatment Of Mrmentioning

confidence: 99%

Navigating the Crossroads of Coronary Artery Disease and Heart Failure

et al. 2006

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“…The newest version of the software that was used in the present study allows us to appreciate the anatomical position of papillary muscles, which is believed to be the most important factor in the mechanisms of functional MR. Functional MR is a common finding in patients with CHF; the presence of functional MR is known to contribute to the progression of ventricular dysfunction and worsens the prognosis in patients with both ischemic/nonischemic heart failure [1,16,[21][22][23][24]. Dynamic reduction of functional MR after vasodilator and diuretic therapy or ACE inhibitor therapy for heart failure has been reported previously [3,[5][6][7][8].…”

Section: Discussionmentioning

confidence: 89%

Dynamics of Mitral Complex Geometry and Functional Mitral Regurgitation During Heart Failure Treatment

Watanabe¹,

Ogasawara

Yamaura³

et al. 2006

J Echocardiogr

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Background. Although mitral complex geometry alteration has been speculated as a major mechanism for the reduction in mitral regurgitation (MR) after heart failure treatment, it has been difficult to recognize the mechanistic changes of the mitral apparatus because of the complex morphology and anatomical position. We investigated the contributions of the dynamic changes in mitral valve geometry with papillary muscle (PM) alignment to the reduction of functional MR after intensive heart failure treatment.Methods. Two dimensional/three-dimensional (2D/3D) echocardiography was performed in 10 patients with decompensated heart failure and functional MR before and after intensive therapy. We used novel software to analyze the volumetric images recorded by real-time 3D echocardiography. Reconstructed 3D images showed both leaflets and annulus configuration in relation to PM position. We measured maximum tenting length (max-Tent-L); mean tenting length (mean-Tent-L) and tenting volume (Tent-V); distances from anterior annulus to anterolateral PM (A-tethering length) and posteromedial PM (P-tethering length); the distance between two PM (interpapillary distance); and the angle made by the anterolateral PM, anterior annulus, and posteromedial PM (interpapillary angle).Results. MR decreased after intensive treatment in all patients (p<0.0001). Leaflet tenting decreased significantly after therapy (max-Tent-L, 16.8 2.5 vs. 13.3 2.0mm, p<0.001; mean-Tent-L, 9.5 2.1 vs. 7.3 1.3mm, p<0.001; Tent-V, 10.3 2.8 vs. 6.2 1.6ml, p=0.0002). P-tethering length shortened (46.9 5.1 vs. 38.6 4.9mm, p<0.001). Interpapillary distance (25.8 5.6 vs. 17.2 4.0mm, p<0.001) and interpapillary angle (32.0 7.3 vs. 23.8 7.5 degree, p<0.001) decreased after treatment.Conclusions. Dynamic changes in PM position during heart failure treatment resulted in the reduction of mitral valve tenting, which improved functional MR. (J Echocardiogr 2006; 4: 51-58)

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“…Patients with a regurgitant volume ≥ 30 ml and an ERO ≥ 20 mm 2 had a higher all-cause and cardiac mortality. Accordingly, quantification of ischemic mitral regurgitation provides major information for risk stratification and clinical decision making in patients with an ischemic cardiomyopathy [64].…”

Section: Quantification Of Mitral Valve Regurgitationmentioning

confidence: 99%