Ischemic mitral regurgitation

Abstract

Ischemic mitral regurgitation (IMR) is a frequent complication of left ventricular (LV) global or regional pathological remodeling due to chronic coronary artery disease. It is not a valve disease but represents the valvular consequences of increased tethering forces and reduced closing forces. IMR is defined as mitral regurgitation caused by chronic changes of LV structure and function due to ischemic heart disease and it worsens the prognosis. In this review, we discuss on etiology, pathophysiology, and mechanisms of IMR, its classification, evaluation, and therapeutic corrective methods of IMR.

Figure 1

Posterior and apical displacement of posterior-medial papillary muscle typically seen with infero-lateral akinesia or dykinesia at the base of the left ventricular. It causes tethering of posterior mitral leaflet leading to coaptation defect and posterior directed mitral regurgitation jet

Figure 2

The mitral regurgitation jet is seen in the posterior-medial commissure. Typically P2 and P3 segments are tethered causing the appearance of pseudo prolapsed of A2/A3 segments of anterior mitral leaflet

Figure 3

Transesophageal echocardiography LAX view showing restricted posterior mitral leaflet with tethering causing pseudo-prolapse of anterior mitral leaflet

Figure 4

Mitral regurgitation jet is posterior directed and wall hugging

Figure 5

Symmetric mitral regurgitation due to tethering of both leaflets. The left ventricular is spherical due to remodeling. This is typically seen in extensive old anterior wall infarction

Figure 6

Calculation of tenting area and height

Figure 7

Treatment algorithm for ischemic mitral regurgitation