Diagnosis and Management of Ischemic Mitral Regurgitation: Evidence-Based Clinical Decision Making at the Point of Care

Seminars in Cardiothoracic and Vascular Anesthesia
Ajay Kumar Jha, Vishwas Malik

Abstract

Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older and ubiquitous cutoff of EROA (effective regurgitant orifice area) and Rvol (regurgitant volume) for IMR has been reinstated in the new guideline after a brief hiatus. There had always been a lack of good-quality evidence for its introduction for guiding IMR severity in the previous guideline, and we still do not have quality evidences that could justify its reintroduction. Unlike primary MR, IMR is usually associated with reduced ejection fraction. Therefore, it appears unrealistic to keep the similar cutoff for primary MR and IMR. The cutoff of severity can be modified according to projected values of Rvol normalized to ejection fraction and EROA normalized to Rvol. In addition, the treatment outcome in these patients is determined by factors (left ventricular dyssynchrony, annular dilatation, tenting area, tenting height, tenting volume, and myocardial viability) other than the simple grading. In this review article, a series of graph have been constructed from the numerical data derived from the literatures on IMR to depict the relationship between EROA, Rvol,...Continue Reading

References

Dec 1, 1992·Journal of the American College of Cardiology·T KonoS Goldstein
Jul 1, 1994·Mayo Clinic Proceedings·J A Rumberger
Jan 1, 1997·Journal of the American College of Cardiology·M Enriquez-SaranoA J Tajik
Apr 20, 2001·The Annals of Thoracic Surgery·A M CalafioreG Di Giammarco
Jul 21, 2001·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·T RydénA Jeppsson
Mar 12, 2003·Journal of the American College of Cardiology·Ole A BreithardtChristoph Stellbrink
Apr 2, 2003·Circulation·Martin G St John SuttonUNKNOWN Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group
Jul 2, 2003·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·William A ZoghbiUNKNOWN American Society of Echocardiography
Dec 10, 2003·Journal of the American College of Cardiology·Patrizio LancellottiLuc A Piérard
Dec 2, 2004·The Journal of Thoracic and Cardiovascular Surgery·Edwin C McGeeDelos M Cosgrove
Jan 18, 2005·Journal of the American College of Cardiology·Francesco GrigioniMaurice Enriquez-Sarano
Mar 9, 2005·The New England Journal of Medicine·John G F ClelandUNKNOWN Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators
Apr 26, 2005·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jerry BraunRobert A E Dion
May 28, 2005·European Journal of Heart Failure·Giovanni CioffiCristina Opasich
Jun 2, 2005·Circulation·Douglas L Mann, Michael R Bristow
Jun 9, 2005·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Saida Zen CampwalaRamdas G Pai
Jul 13, 2005·Circulation·Robert Roberts, Ulrich Sigwart
Jul 26, 2005·The Annals of Thoracic Surgery·Daniel R WongDavid F Torchiana
Feb 4, 2006·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Alejandro GisbertArsène J Basmadjian
Feb 21, 2006·The Annals of Thoracic Surgery·Michael A BorgerTirone E David
Mar 7, 2006·The Journal of Thoracic and Cardiovascular Surgery·K SerriA J Basmadjian
Aug 9, 2006·The American Journal of Cardiology·Vorachai KongsaerepongTakahiro Shiota

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Citations

Aug 14, 2019·Seminars in Cardiothoracic and Vascular Anesthesia·Jiapeng HuangNathaen Weitzel

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Methods Mentioned

BETA
coronary artery bypass

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