Article (Scientific journals)
Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment.
PIERARD, Luc; Carabello, B. A.
2010In European Heart Journal, 31, p. 2996-3005
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Abstract :
[en] Ischaemic mitral regurgitation is a frequent complication of left ventricular global or regional pathological remodelling due to chronic coronary artery disease. It is not a valve disease but represents the valvular consequences of increased tethering forces (papillary muscles displacement leading to a more apical position of the leaflets and their coaptation point) and reduced closing forces (reduced contractility, dyssynchrony of the papillary muscles, intra-left ventricular dyssynchrony). Although mitral regurgitation has an unloading effect and reduces impedance, the volume overload begets further left ventricular dilatation, increases ventricular wall stress leading to worsened performance. Ischaemic mitral regurgitation is characteristically dynamic: its severity may vary with haemodynamic conditions. Both the severity of ischaemic mitral regurgitation and its dynamic component worsen prognosis. There are numerous possible treatment modalities, but the management of the individual patient remains difficult. Medical therapy is mandatory; revascularization procedures are frequently not sufficient to reduce mitral regurgitation; the role of combined surgical therapy by mitral valve repair is not yet defined in the absence of large randomized trial. Some patients are good candidates for cardiac resynchronization therapy that may reduce the amount of regurgitation. New therapeutic targets are under investigation.
Disciplines :
General & internal medicine
Author, co-author :
PIERARD, Luc ;  Centre Hospitalier Universitaire de Liège - CHU > Cardiologie
Carabello, B. A.
Language :
English
Title :
Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment.
Publication date :
2010
Journal title :
European Heart Journal
ISSN :
0195-668X
eISSN :
1522-9645
Publisher :
Oxford University Press, Oxford, United Kingdom
Volume :
31
Pages :
2996-3005
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 01 September 2011

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