Understanding Ischemic mitral regurgitation … think of a tethered cow that ’ s randomly grazing !
The mechanism of MR in ischemic /Functional is complex. Technically, pure ischemic MR should have a structurally normal leaflet and the subvalvular mechanism dominates But,the combination of the two is also prevalent. In fact, a degenerative component is added to this in many elderly patients.
Mechanism of Ischemic mitral regurgitation
Any of the following may contribute either alone or in in different combinations.
Global LV dilatation with or without annular dilatation
Spherical left ventricle
Altered inter papillary muscle distance (Degree and direction of posterior vs apical displacement of pap muscle)
Chordal shortening /Lengthening/Abnormal tethering
Leaflet tenting distance and volume
Basal LV dysfunction and Local LV (Sub-mitral) remodeling
We have come a long way , since the days of Carpentier and Duran who did pioneering work .It involved partial or complete mitral annular stabilization with surgical ring technology that helped us to change the shape of the annulus. Advanced imaging, with 3 D printing will enable us to procure perfectly matched designer valve rings and (may be leaflets also) in the near future. Percutaneous mitral valve Interventions, with clips , valve, are going to dominate the mitral valve therapeutics.
Still, we are largely ignorant about Individual contribution from various components in the genesis of ischemic /functional MR. This becomes important because the preservation of native valve is better on any day than replacing. One ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: Mitral annulus -Functional mitral regurgitation ischemic functional mitral regurgitation mitraclip mitral valve tethering neo chordae implantation papillary muscle papillary muscle dysfunction secondory mitral regurgitation valve in valve Source Type: blogs
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