Current management of ischemic mitral regurgitation

Severe coronary artery disease and myocardial infarction can be complicated by ischemic mitral regurgitation (IMR). IMR results from left ventricular remodeling after myocardial infarction and in rare instances can accompany acute ischemia. A better understanding of the pathophysiology of IMR and increased awareness of its negative impact on long-term survival explain the recent rise in the number of patients referred for surgical correction of IMR at the time of coronary revascularization. The most common mechanism of IMR is Carpentier's type IIIb dysfunction, for which an undersized remodeling annuloplasty is the treatment of choice. In this article we define ischemic mitral regurgitation and review its pathophysiology, clinical presentations, diagnosis, indication for surgery, and management.