Mitral Regurgitation in Coronary Artery Disease

The aim of the study was to assess the results of mitral valve surgery in patients with chronic coronary artery disease, subjected to concomitant coronary artery by-pass grafting (CABG). Material and methods. The study group comprised 24 patients (aged 48-72) with coronary artery disease and significant ischemic mitral regurgitation, who qualified for mitral annuloplasty concomitant with CABG. All patients underwent a review of medical history, NYHA and CCS class evaluation, electrocardiography, transthoracic echocardiography and coronarography. Patients were subjected to intra-operative transesophageal echocardiography; in the early postoperative period their clinical state was assessed and electrocardiography and transthoracic echocardiography were performed. The followup, 6-12 months after the surgery, included history of life comfort, NYHA and CCS class evaluation, electrocardiography and transthoracic echocardiography. Echocardiographic parameters were analyzed using Student's t-test and the STATISTICA 7.1 program. Results. Most patients were qualified into NYHA classes I and II postoperatively, as compared to class II, III or IV before the surgery. According to CCS class, 16 patients were asymptomatic and four were class I. Based on NYHA and CCS classes, patient life comfort was assessed before and after the surgery. Life comfort was improved in 20 patients. An improvement was achieved in all studied echocardiographic parameters, left ventricular ejection fraction, left ventricular end-systolic and diastolic diameters, left atrial diameter, vena contracta, effective regurgitant orifice, regurgitant volume, proximal isovelocity surface area, and regurgitant jet area. Pre-and postoperative mitral regurgitation grades were assessed: 13 patients had grade IV, eight had grade III and three had grade II mitral regurgitation prior to surgery, as compared to trace or grade I in 22 patients after surgery, and grade II in one patient following peri-operative myocardial infarction. Conclusions. Mitral annuloplasty concomitant with CABG significantly improved hemodynamic heart parameters, particularly left ventricular systolic function and ejection fraction, decreased left ventricular and left atrial dimensions, significantly reduced MR grades and improved patient life comfort.

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“…Balu et al and Tolis have demonstrated that heart revascularization decreases MR (21,22), and similar results have been achieved in our study.…”

Section: Evaluation Of the Results Of Surgical Treatment In Ischaemicsupporting

confidence: 92%

Evaluation of the Results of Surgical Treatment in Ischaemic Mitral Regurgitation

Wojtasik-Anioł¹,

Adamek-Kośmider²,

Wojtasik³

et al. 2008

Polish Journal of Surgery

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“…The prognosis in such patients has been related to LV function at the time of surgery.32 A significant number of such patients have reversible ischemic dysfunction, allowing improvement in LV function after surgery.33 If MR is related to reduced global LV function secondary to ischemia, it should also reverse after revascularization, as has been reported in an uncontrolled study. 34 Based on our data, we would speculate that patients with coronary artery disease, poor LV function, and MR, in whom ischemia can be demonstrated using techniques such as thallium-201 imaging,35 may not need to undergo valve replacement unless the mitral apparatus itself is structurally damaged. Because the mitral annulus is usually enlarged in such patients, a limited form of valve repair, such as annuloplasty with or without ring placement, may be desirable.…”

Section: Possible Clinical Implicationsmentioning

confidence: 88%

Mechanism of ischemic mitral regurgitation. An experimental evaluation.

et al. 1991

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Background. Papillary muscle dysfunction (PMD) has been implicated in the pathogenesis of ischemic mitral regurgitation (MR). We hypothesized that ischemic MR is not caused by PMD and/or dysfunction of the myocardial regions from where the papillary muscles arise but is related to reduction in global left ventricular (LV) function. To test this hypothesis, three groups of dogs were studied.Methods and Results. In group 1 dogs (n=8), varying degrees of regional and global LV

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“…Proponents for treating mild-to-moderate ischemic MR with revascularization alone argue that revascularization improves regional contractility and restores MV-papillary muscle continuity, thus normalizing MV function [14, 15]. On the other hand, proponents for a more aggressive treatment strategy cite the negative consequences of ongoing MR. Myocardial revascularization alone may be insufficient to restore normal ventricular physiology once MR develops.…”

Section: Introductionmentioning

confidence: 99%

Design, rationale, and initiation of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation Trial: A report from the Cardiothoracic Surgical Trials Network

Smith

Michler

Woo

et al. 2012

The Journal of Thoracic and Cardiovascular Surgery

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Background Patients with moderate ischemic mitral regurgitation have demonstrably poorer outcome compared to coronary artery disease patients without mitral regurgitation. The optimal treatment of this condition has become increasingly controversial and a randomized trial evaluating current practices is warranted. Methods and Results We describe the design and initial execution of the Cardiothoracic Surgical Trials Network moderate ischemic mitral regurgitation trial. This is an ongoing prospective, multi-center, randomized, controlled clinical trial designed to test the safety and efficacy of mitral repair in addition to coronary artery bypass grafting in the treatment of moderate ischemic mitral regurgitation. Conclusion The results of the Cardiothoracic Surgical Trials Network ischemic mitral regurgitation trials will provide long-awaited information on controversial therapies for a morbid disease process.

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Mitral Regurgitation in Coronary Artery Disease

Cited by 43 publications

References 4 publications

Evaluation of the Results of Surgical Treatment in Ischaemic Mitral Regurgitation

Evaluation of the Results of Surgical Treatment in Ischaemic Mitral Regurgitation

Mechanism of ischemic mitral regurgitation. An experimental evaluation.

Design, rationale, and initiation of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation Trial: A report from the Cardiothoracic Surgical Trials Network

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