Coronary artery bypass grafting (CABG) alone in moderate ischemic mitral regurgitation: is CABG really enough?

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A Comparison of 2 Mitral Annuloplasty Rings for Severe Ischemic Mitral Regurgitation: Clinical and Echocardiographic Outcomes.

Controversies regarding the choice of annuloplasty rings for treatment of ischemic mitral regurgitation still exist. Aim of the study is to compare early performance of 2 different rings in terms of rest and exercise echocardiographic parameters (transmitral gradient, systolic pulmonary artery pressure, and mitral valve area), clinical outcomes, and recurrence of mitral regurgitation. From January 2008 till December 2013, prospectively collected data of patients who underwent coronary artery bypass grafting and undersizing mitral valve annuloplasty for severe chronic ischemic mitral regurgitation at our Institution were reviewed. A total of 93 patients were identified; among them 44 had semirigid Memo 3D ring implanted (group A) whereas 49 had a rigid profile 3D ring (group B). At 6 months, recurrent ischemic mitral regurgitation, equal or more than moderate, was observed in 4 and 6 patients in the group A and B, respectively (P = 0.74). Group A showed certain improved valve geometric parameters such as posterior leaflet angle, tenting area, and coaptation depth. Transmitral gradient was significantly higher at rest in the group B (P < 0.0001). During exercise, significant increase of transmitral gradient and systolic pulmonary artery pressure was observed in group B (P < 0.0001). Mitral valve area was not statistically significantly smaller at rest in between groups (P = 0.09); however, it significantly decreased with exercise in group B (P = 0.01). At midterm follow-up, patients in group B were more symptomatic. In patients with chronic ischemic mitral regurgitation, use of semirigid Memo 3D ring when compared to the rigid Profile 3D may be associated with early improved mitral valve geometrical conformation and hemodynamic profile, particularly during exercise. No difference was observed between both groups in recurrent mitral regurgitation.Peer reviewe

The effect of pure mitral regurgitation on mitral annular geometry and three-dimensional saddle shape

ObjectiveChronic ischemic mitral regurgitation is associated with mitral annular dilatation in the septal-lateral dimension and flattening of the annular 3-dimensional saddle shape. To examine whether these perturbations are caused by the ischemic insult, mitral regurgitation, or both, we investigated the effects of pure mitral regurgitation (low pressure volume overload) on annular geometry and shape.MethodsEight radiopaque markers were sutured evenly around the mitral annulus in sheep randomized to control (CTRL, n = 8) or experimental (HOLE, n = 12) groups. In HOLE, a 3.5- to 4.8-mm hole was punched in the posterior leaflet to generate pure mitral regurgitation. Four-dimensional marker coordinates were obtained radiographically 1 and 12 weeks postoperatively. Mitral annular area, annular septal-lateral and commissure–commissure dimensions, and annular height were calculated every 16.7 ms.ResultsMitral regurgitation grade was 0.4 ± 0.4 in CTRL and 3.0 ± 0.8 in HOLE (P < .001) at 12 weeks. End-diastolic left ventricular volume index was greater in HOLE at both 1 and 12 weeks; end-systolic volume index was larger in HOLE at 12 weeks. Mitral annular area increased in HOLE predominantly in the commissure–commissure dimension, with no difference in annular height between HOLE versus CTRL at 1 or 12 weeks, respectively.ConclusionIn contrast with annular septal-lateral dilatation and flattening of the annular saddle shape observed with chronic ischemic mitral regurgitation, pure mitral regurgitation was associated with commissure–commissure dimension annular dilatation and no change in annular shape. Thus, infarction is a more important determinant of septal-lateral dilatation and annular shape than mitral regurgitation, which reinforces the need for disease-specific designs of annuloplasty rings

Pattern of Cardiovascular Diseases Among Elderly Patients Admitted in Medical Wards at Muhimbili National Hospital Dar es salaam Tanzania

Cardiovascular disease is the most frequent cause of death in persons over the age 50 years and most importantly it is responsible for considerable morbidity and large burden of disability in the community. Cardiovascular diseases are an increasing cause of admissions among elderly in Africa, yet little research is available on pattern and magnitude of the problem. To determine the pattern of cardiovascular disease in elderly patients admitted in medical wards at Muhimbili National Hospital Dar es Salaam Tanzania. This was a descriptive cross sectional study that was carried our between September 2008 and September 2009. Social demographic information; medical history physical examination; electrocardiographic and echocardiography examination; biochemical and haematological parameters were collected from study patients One hundred eighty five elderly patients admitted at MNH, medical department, were enrolled into the study, all were of African black race. Majority, 116 (62.7%), were male. Their mean age was 66.1 (SD, 9.3; range, 50-87) years. The mean body mass index\ud (BMI) was 23.9 (SD, 3.9; range, 16.6-40.1) kg/m2. Hypertension was the most frequent condition encountered affecting both males (67.2%)and females (68.1%). Congestive heart failure was second common condition affecting 37% elderly patients. According to the echocardiogram findings, among 185 elderly patients 68.6% were diagnosed to have cardiovascular disease. There were no significant sex differences in the prevalence of cardiac disease (p>005). The commonest echocardiographic diagnosis were left ventricular hypertrophy (LVH) secondary to hypertension found in 45%, diastolic dysfunction found in 31% and systolic dysfunction 25%.The least common types were septal defect, pulmonary hypertension and calcified mitral valve found in one percent each. The commonest clinical presentations were palpitations, dyspnoea, orthopnoea, pedal oedema and right upper quadrant abdominal pain. Obese patients presenting with cardiovascular abnormalities were 9 (7.1%). Anaemia was the leading co- morbidity affecting 90.3% of the patients Hypertension, congestive heart failure and left ventricular hypertrophy were the commonest cardiovascular diseases among elderly patients at MNH. Coexistence of anaemia, stroke, renal impairment and diabetes was also frequent. Elderly patients should be screened for cardiovascular diseases especially hypertension whenever they are admitted to the hospital even if the reasons for admission are not cardiovascular problems.\u

Echocardiographic Evaluation of Papillary Muscle function in Ischemic Mitral Regurgitation.

Ischemic mitral regurgitation is defined as mitral regurgitation due to coronary artery disease with structurally normal mitral valve leaflet and chordae. Some authors prefer to use the term as functional mirtal regurgitation. But functional mitral regurgitation can occur in idiopathic dilated cardiomyopathy without coronary artery disease. So Ischemic mitral regurgitation and functional mitral regurgitation are not synonymous. The incidence of coronary artery diseases in rural and urban population in India is reported to be between 14.8 per thousand to 65.4 per thousand(2). Patients with coronary artery diseases during their course may develop complications such as arrhythmias, mechanical complications (ventricular septal rupture, Ischemic mitral regurgitation) and pump failure. Ischemic mitral regurgitation occurs in approximately 20% of patients after myocardial infarction and 56% of patients with heart failure due to ischemic or non ischemic cardiomyopathy. Ischemic mitral regurgitation can occur in coronary artery disease both during acute phase and chronic phase. Ischemic mitral regurgitation is more common in inferior wall myocardial infarction than anterior wall myocardial infarction. There is a graded independent association between the severity of ischemic MR and the development of Heart failure after myocardial infarction. Even mild ischemic MR is associated with an increase in the risk of heart failure. Ischemic mitral regurgitation is an independent prognostic factor in patients with chest pain even without myocardial infarction. Advancing age, female gender, multiple vessel coronary artery disease, congestive heart failure, recurrent ischemia, large infarct size, and prior acute myocardial infarction are all risk factors for developing IMR. THE AIM OF THE STUDY: 1) To assess the mechanisms of ischemic mitral regurgitation in patients with old myocardial infarction. 2) To assess the role of Tissue Doppler imaging in evaluation of papillary muscle function. 3) To assess the contribution of papillary muscle dysfunction in the pathogenesis of ischemic mitral regurgitation. CONCLUSIONS: 1. Mitral leaflet tethering distance is consistently directly proportional to severity of Ischemic mitral regurgitation. 2. Papillary muscle function is better assessed by tissue Doppler echo than M Mode and 2D echocardiography. 3. Papillary muscle dysfunction is not an independent determinant of ischemic MR in all cases. 4. Papillary muscle dysfunction attenuates ischemic MR in patients with old inferior wall MI with increased left ventricular sphericity due to focal remodeling. 5. Role of papillary muscle dysfunction in ischemic MR is still elusive and varies depending on factors such as location of myocardial infarction and extent of left ventricular remodeling

Results of Surgical Managment of Primary Mitral Regurgitation in a Single-center Study

Mitral regurgitation (MR) remains the second dominant defect in the structure of valvular cardiac diseases.It affects more than 2 million people in the USA. Basic causes are classified as degenerative (with valve prolapse) and ischemic (due to ischemic heart disease) in advanced countries or rheumatic ones (in developing countries).Alone radical method of MR treatment is surgical correction through mitral valve repair (MVRe) or replacement (MVR) yielding definitely higher survival percentage and improvement of heart failure (HF) class comparing to pharmacotherapy.Evolution of approaches to the management of non-ischemic MR passed through some stages starting from predominantly MVR to organ-preserving approaches like plastic repair.In the prospective single-center study were analyzed the results of treatment of 72 patients with primary MR (PMR) who were subjected to mitral valve replacement (MVR) or plastic mitral valve repair (MVRe) performed in the Department of cardiac surgery affiliated with Lviv regional clinical hospital (Ukraine) since October, 2013 till February, 2016.The conclusions of performed study are next:1) Key direct cause of MR is the chordal rupture of MV cusps; etiological factor in the majority of advanced countries is degenerative changes in contrast to rheumatic changes in the developing countries.2) Principal method of MR surgical correction in out center is MVR, though the preferable global trend is MVRe.3) Complications and lethality percentages in this study were higher among the patients from MVR group. Improvement of HF class according to NYHA was more evident in the MVRe group.This corresponds to results of other studies and guidelines that recommend MVRe as optional method for MR correction

Chronic ischemic mitral regurgitation

peer reviewe

Intracardiac Calcification - An Interesting Chest X-ray Report.

We report a case of chest X-ray finding of mitral annular calcification. Mitral annular calcification is a degenerative process involving the fibrous annulus of the mitral valve. It is generally an incidental finding associated with aging and atherosclerosis. It may lead to significant mitral regurgitation and can rarely cause symptomatic mitral stenosis. In addition, mitral annulus calcification may be associated with atrial fibrillation and cardiac arrhythmia. Calcification of mitral annulus in the chest X-ray generally follows the C-shape of the mitral annulus. Confirmation is by echocardiography. Symptomatic cases require repair by surgery