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Review
. 2016 Dec;8(12):3752-3761.
doi: 10.21037/jtd.2016.12.33.

Ischemic mitral valve prolapse

Francesco Nappi  1 , Spadaccio Cristiano  2 , Antonio Nenna  3 , Massimo Chello  3
Affiliations
Review

Ischemic mitral valve prolapse

Francesco Nappi et al. J Thorac Dis. 2016 Dec.

Abstract

Ischemic mitral prolapse (IMP) is a pathologic entity encountered in about one-third among the patients undergoing surgery for ischemic mitral regurgitation (IMR). IMP is generally the result of a papillary muscle injury consequent to myocardial, but the recent literature is progressively unveiling a more complex pathogenesis. The mechanisms underlying its development regards the impairment of one or more components of the mitral apparatus, which comprises the annulus, the chordae tendineae, the papillary muscle and the left ventricular wall. IMP is not only a disorder of valvular function, but also entails coexistent aspects of a geometric disturbance of the mitral valve configuration and of the left ventricular function and dimension and a correct understanding of all these aspects is crucial to guide and tailor the correct therapeutic strategy to be adopted. Localization of prolapse, anatomic features of the prolapsed leaflets and the subvalvular apparatus should be carefully evaluated as also constituting the major determinants defining patient's outcomes. This review will summarize our current understanding of the pathophysiology and clinical evidence on IMP with a particular focus on the surgical treatment.

Keywords: Mitral valve; functional mitral regurgitation; ischemic mitral regurgitation (IMR); prolapse; surgery.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Anatomy of the mitral valve apparatus. (A) Mitral valve and anatomical description of anterior, posterior leaflet and relative scallops; (B) representation of papillary muscle and chordae tendineae with attachment on the mitral leaflets.
Figure 2
Figure 2
Mechanisms of ischemic valve prolapse (see text).
Figure 3
Figure 3
Surgical reparative strategies. (A) Papillary muscle approximation (PMA). A Gore-tex cap is used to reinforce the heads of the papillary muscle and a Gore-tex 4-0 suture is used to approximate the two papillary muscles and therefore increase leaflets coaptation; (B) mitral annuloplasty performed in association to PMA (red rectangle). APM, anterior papillary musclePPM: posterior papillary muscle.
See this image and copyright information in PMC

References

    1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2438-88. 10.1016/j.jacc.2014.02.537 - DOI - PubMed
    1. Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010;11:307-32. 10.1093/ejechocard/jeq031 - DOI - PubMed
    1. Nappi F, Nenna A, Spadaccio C, et al. Predictive factors of long-term results following valve repair in ischemic mitral valve prolapse. Int J Cardiol 2016;204:218-28. 10.1016/j.ijcard.2015.11.137 - DOI - PubMed
    1. Jouan J, Tapia M, C, Cook R, et al. Ischemic mitral valve prolapse: mechanisms and implications for valve repair. Eur J Cardiothorac Surg 2004;26:1112-7. 10.1016/j.ejcts.2004.07.049 - DOI - PubMed
    1. Marwick TH, Lancellotti P, Pierard L. Ischaemic mitral regurgitation: mechanisms and diagnosis. Heart 2009;95:1711-8. 10.1136/hrt.2007.135335 - DOI - PubMed

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