J.Jpn. Surg. Soc.. 107(1): 21-26, 2006

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Feature topic

SURGICAL TREATMENT OF ISCHEMIC MITRAL REGURGITATION

Ischemic mitral regurgitation (IMR) is a serious problem, which conveys adverse prognosis, doubling mortality after myocardial infarction. It is common and increases mortality even when mild. IMR is often associated with the occlusion of left circumflex coronary artery, such as second or third obtuse marginal branches by experimental model. However, cause of IMR still remains unclear in many respects. Several study using echocardiography and magnetic resonance imaging show some probable reasons, left ventricular structure and deformity of left ventricle may cause mitral leaflet restriction and mitral annulus deformity, lead to tethering. The aim of surgical treatment of IMR is to reduce the grade of mitral regurgitation and left ventricular remodeling. Recent study clarified the advantage of valve repair in IMR opposed to valve replacement that may affect the patient poor quality of life. Some new technique of saddle shaped ring repair, second chordal cutting, edge-to-edge repair are available but these long term outcome remain unclear. It may be effective combined left ventricular revascularization and mitral valve repair. Understanding mechanism of IMR will improve therapies for targeted primary causes with new therapeutic options provided a more flexible approach for surgical repair of IMR.

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