Ischemic mitral regurgitation: the role of the »edge-to-edge« repair

Mitral insufficiency is considered to be ischemic in origin when the valve leaflet and chordae are structurally normal and the valve dysfunction is caused by the consequences of myocardial infarction. The main mechanism responsible for ischemic mitral regurgitation (IMR) is tethering of the leaflets which may result either from localized or diffuse left ventricular dysfunction with changes in geometry of the left ventricle (LV) and displacement of one or both papillary muscles. Annular dilatation is often concomitantly present, particularly when the valve insufficiency is severe and long-standing and the LV is remarkably dilated. The diagnosis of IMR is provided by echocardiography, which is able to show the location of the regurgitant jet, the presence of global and regional ventricular wall motion abnormalities, and the severity of MR. Since the mitral valve is structurally normal in the majority of patients with IMR, inspection during the operation is not helpful, and the surgical procedure is guided by the information provided by echocardiography.