Ischemic Mitral Regurgitation (IMR)

Severe IMR : According to ESC guidelines, severe IMR is defined with ERO> 20 mm2 and RV > 30 cc and according to ACC/AHA guidelines, severe IMR is defined as ERO≥40 mm2 and RV≥ 60 cc.Role of echocardiography: TTE and TEE have crucial roles for determining severity and mechanism of MR and possibility of MV repair.3D echocardiography adds further diagnostic data for evaluation of MR.Treatment: In severe IMR undergoing CABG, MV surgery has class I indication according to ESC and IIa according to ACC/AHA guidelines.If LVEF<30% , surgery is indicated if viable myocardium presents (IIa,ESC(If LVEF> 30% but revascularization is not possible, and patient remains asymptomatic despite medical treatment, surgery or MV clip have class IIb indication (ESC). By LVEF<30% CRT and MV clip have class IIb indication. (ESC(MVR with preserved chorda is better than MV repair with undersize ring annuloplasty for stage D ( exertional dyspnea),( NEW: An RCT has shown that mitral valve repair is associated with a higher rate of recurrence of moderate or severe MR than that associated with mitral valve replacement (MVR) in patients with severe, symptomatic, ischemic MR, without a difference in mortality rate at 2 years’ follow-up). ACC/AHA.Performing MV repair for moderate IMR is class IIb, The 2014 recommendation supported mitral valve repair in this group of patients. An RCT showed no clinical benefit of mitral repair in this population of patients, with increased risk of postoperative complications. (ACC/AHA)