Ischemic mitral valve regurgitation: the new challenge for magnetic resonance imaging

D’Ancona, Giuseppe; Mamone, Giuseppe; Marrone, Gianluca; Pirone, Francesco; Santise, Gianluca; Sciacca, Sergio; Pilato, Michele

doi:10.1016/j.ejcts.2007.06.023

Cited by 12 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They may provide superior-quality images and measurements compared to echocardiography [64][65][66][67]. However, their incremental value over TTE and TEE in clinical and surgical decision making remain to be determined.…”

Section: New Imaging Modalitiesmentioning

confidence: 97%

See 1 more Smart Citation

Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches☆

Bouma

Horst²,

Hamer

et al. 2010

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Chronic ischaemic mitral regurgitation (CIMR) remains one of the most complex and unresolved aspects in the management of ischaemic heart disease. This review provides an overview of the present knowledge about the different aspects of CIMR with an emphasis on mechanisms, current surgical treatment results and new mechanism-based surgical approaches. CIMR occurs in approximately 20-25% of patients followed up after myocardial infarction (MI) and in 50% of those with post-infarct congestive heart failure (CHF). The presence of CIMR adversely affects prognosis, increasing mortality and the risk of CHF in a graded fashion according to CIMR severity. The primary mechanism of CIMR is ischaemia-induced left ventricular (LV) remodelling with papillary muscle displacement and apical tenting of the mitral valve leaflets. CIMR is often clinically silent, and colour-Doppler echocardiography remains the most reliable diagnostic tool. The most commonly performed surgical procedure for CIMR (restrictive annuloplasty combined with coronary artery bypass grafting (CABG)) can provide good results in selected patients with minimal LV dilatation and minimal tenting. However, in general the persistence and recurrence rate (at least MR grade 3+) for restrictive annuloplasty remains high (up to 30% at 6 months postoperatively), and after a 10-year follow-up there does not appear to be a survival benefit of a combined procedure compared to CABG alone (10-year survival rate for both is approximately 50%). Patients at risk of annuloplasty failure based on preoperative echocardiographic and clinical parameters may benefit from mitral valve replacement with preservation of the subvalvular apparatus or from new alternative procedures targeting the subvalvular apparatus including the LV. These new procedures include second-order chordal cutting, papillary muscle repositioning by a variety of techniques and ventricular approaches using external ventricular restraint devices or the Coapsys device. In addition, percutaneous transvenous repair techniques are being developed. Although promising, at this point these new procedures still lack investigation in large patient cohorts with long-term follow-up. They will, however, be the subject of much anticipated and necessary ongoing and future research.

show abstract

Section: New Imaging Modalitiesmentioning

confidence: 97%

“…In addition to TTE and TEE, new imaging modalities for the assessment of CIMR, such as three-dimensional echocardiography and cardiac magnetic resonance imaging (CMRI), are subject of ongoing investigation [64][65][66][67]. They may provide superior-quality images and measurements compared to echocardiography [64][65][66][67].…”

Section: New Imaging Modalitiesmentioning

confidence: 98%

Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches☆

Bouma

Horst²,

Hamer

et al. 2010

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…However, its usefulness in real life has not been fully addressed. Since FMR results from LV geometrical changes in patients with LV dilatation/dysfunction, a comprehensive imaging technique addressing both LV and [6][7][8][9][10][12][13][14][15]. Significant greater volumes and worst ejection fraction in patients with MR were noted, as well as significant differences in MV parameters.…”

Section: Anatomy Evaluation With Cmrmentioning

confidence: 99%

“…It allows reproducible evaluation of LV volumes and function in patients with LV dilatation/dysfunction of diverse etiologies as well as a comprehensive morphological cardiac evaluation without limitations of image quality. Several studies have evaluated its usefulness in the evaluation of the mitral valve (MV) apparatus anatomy showing promising results in different diseases [12][13][14][15][16]. In patients with ILVD, a close relationship between left ventricular volumes, MV apparatus geometry (interpapillary muscle distance, mitral annulus to the medial papillary muscle root distance, mitral tenting area, regional left ventricular myocardial scarring, and different mitral annular dimensions) and presence of FMR by CMR have been reported as well [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction

Fernández-Golfín

Agustin

Manzano

et al. 2010

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction below 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.

show abstract

“…Ischemic cardiomyopathy is another common cause of mitral regurgitation (Fig 11; Movie 3 [online]) (17). In this case the valve is normal, but regional wall motion abnormalities, left ventricular dilatation, or annular dilatation, alone or in combination, lead to dysfunction of the mitral apparatus with "functional" mitral regurgitation.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

CT and MR Imaging of the Mitral Valve: Radiologic-Pathologic Correlation

Morris¹,

Maleszewski²,

Suri

et al. 2010

RadioGraphics

View full text Add to dashboard Cite

Ischemic mitral valve regurgitation: the new challenge for magnetic resonance imaging

Cited by 12 publications

References 19 publications

Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches☆

Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches☆

Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction

CT and MR Imaging of the Mitral Valve: Radiologic-Pathologic Correlation

Contact Info

Product

Resources

About