Ischaemic Mitral

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Ischaemic Mitral Regurgitation

• Ruchan AKAR
• AUTF, Ankara, TURKEY

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SURGICAL TREATMENT OPTIONS
Remodelling Strawberry
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Reductive annuloplasty
Surgical goal to reduce and fix the mitral
annular dimension in the anterior-posterior axis
Craig Miller D. J Thorac Cardiovasc Surg
20011221059-1062
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Chordal Sparing MVR

• Infarcted or ruptured papillary muscle
• Complex MR leak
• Lateral LV wall motion abnormality
• Considerable apical leaflet tenting

Limited life expectancy !
Craig Miller D. J Thorac Cardiovasc Surg
20011221059-1062
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The double-orifice technique
Maisano et al. Eur. J. Cardiothorac. Surg. 17
201-205.
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Left ventricular reduction
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COOLEY DOR JATENE T. DAVID FONTAN BUCKBERG
Left ventricular restoration by endoventricular
patch repair the Dor Procedure
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Partial left ventriculectomy The Batista
operation The mitral subvalvular apparatus is
preserved by re-implanting the papillary muscles
at the margins of the ventriculotomy
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LV remodeling by infarct plication
Liel Cohen et al. Circulation, Volume
101(23).June 13, 2000.2756-2763
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Chordal Cutting
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Timing of surgery in IMR
Prompt mitral surgery

Ruptured papillary muscle Yes Functional
IMR CABG indicated for angina Severe MR (ERO
20mm2) Yes Mild or moderate MR (ERO lt
20mm2) Possible yes Trace MR No
Enriquez-Sarano M. Heart 20028779-85
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Timing of surgery in IMR
Prompt mitral surgery

Functional IMR CABG not indicated for angina but
possible Severe MR (ERO gt 20mm2) Yes Mild or
moderate MR (ERO lt 20mm2) History of CHF and
viable myocardium Possible yes No or mild
symptoms, no viability Uncertain Trace
MR No
Enriquez-Sarano M. Heart 20028779-85
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Liel Cohen Circulation, Volume 101(23).June 13,
2000.2756-2763
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Liel Cohen Circulation, Volume 101(23).June 13,
2000.2756-2763
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From   Liel Cohen Circulation, Volume
101(23).June 13, 2000.2756-2763
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J-shaped complex LV wall PM Mitral annulus
Komeda et al. J Thorac Cardiovasc Surg
1997113292-301