Ischemic Mitral Regurgitation Before and After CABG

Ischemic mitral regurgitation (MR) remains one of the greatest challenges in the management of patients with ischemic heart disease. Ischemic MR is defined as mitral regurgitation appearing as a complication of coronary artery disease in which the morphology of the mitral valve’s leaflets is normal. Therefore ischemic MR may be present in coronary artery disease prior to surgical myocardial revascularization or after revascularisation, determined by pre-existing morphological left ventricle changes or by new graft disease. Ischemic MR has a very complex mechanism including multiple factors: left ventricle global and regional remodelling, annular dilatation and flattening, or mechanic dysynchrony. Echocardiography (including transesophageal and 3D echocardiography) remains the method of choice for estimating mitral valve regurgitation severity and mechanism, while the new methods (cardiac magnetic resonance, computer tomography) may be helpful in specific clinical scenarios. The indication for surgery is still controversial in ischemic mitral regurgitation due to the absence of evidence that intervention on mitral valve improves the long-term prognosis.