The effect of the revascularization strategies on the severity of ischemic moderate mitral regurgitation

Abstract.Although it is known thatrevascularization is useful for the treatment of patients with ischemic mitralregurgitation (MR), the effects of revascularization on MR have not been wellexamined. In this study, we aimed to show the effect of revascularizationstrategies on patients with moderate ischemic MR, quantitatively andprospectively. Forty-sevenpatients with moderate MR (2 to 3 +) who were offered revascularization due tothe diagnosis of coronary artery disease were enrolled in the study. Patientswere divided into three groups according to their treatment strategies.Patients who underwent percutaneous coronary intervention (PCI) were defined asgroup 1 (n=18), patients who underwent surgical revascularization (CABG) asgroup 2 (n=17) and patients who received only medical treatment as group 3(n=12). Transthoracic echocardiography (TTE) was performed for all patients atthe beginning of the study, and after three months. MR grading was performedusing semi-quantitative (I-IV) and quantitative (EOA, RV, and RF) methods.Initial MR gradingparameters of the three groups were similar. When the initial and the thirdmonth MR parameters of patients were compared, there was a significant decreasein group 1 ineffective orifice area (EOA) (p=0.002), regurgitant volume (RV) (p=0.005),regurgitant fraction (RF) (p=0.002) and semi-quantitative MR (p=0.002). Therewas also a significant decrease in group 2 in EOA (p=0.002), RV (p=0.001), RF (p=0.001)and semi-quantitative MR (p=0.005) grades after 3 months. However, mitralregurgitation severity was not changed with medical treatment in group 3. .There was no difference between groups when residual MR grades at the third monthwere compared with each other (p>0.05).Our study showedthat percutaneous or surgical revascularization strategies significantlyimproved MR parameters, on the other hand no improvement was obtained withmedical treatment. In spite of the improvement in the severity of MR, therewere still significant residual MR after revascularization strategies withoutvalvular intervention.  For this reasonit can be suggested that revascularization strategies without valvularintervention is effective but not sufficient for the treatment of patients withischemic MR.Key words: Ischemic mitral regurgitation, PISA, revascularization