The effect of the revascularization strategies on the severity of ischemic moderate mitral regurgitation

Abstract

Abstract.Although it is known thatrevascularization is useful for the treatment of patients with ischemic mitralregurgitation (MR), the effects of revascularization on MR have not been wellexamined. In this study, we aimed to show the effect of revascularizationstrategies on patients with moderate ischemic MR, quantitatively andprospectively. Forty-sevenpatients with moderate MR (2 to 3 +) who were offered revascularization due tothe diagnosis of coronary artery disease were enrolled in the study. Patientswere divided into three groups according to their treatment strategies.Patients who underwent percutaneous coronary intervention (PCI) were defined asgroup 1 (n=18), patients who underwent surgical revascularization (CABG) asgroup 2 (n=17) and patients who received only medical treatment as group 3(n=12). Transthoracic echocardiography (TTE) was performed for all patients atthe beginning of the study, and after three months. MR grading was performedusing semi-quantitative (I-IV) and quantitative (EOA, RV, and RF) methods.Initial MR gradingparameters of the three groups were similar. When the initial and the thirdmonth MR parameters of patients were compared, there was a significant decreasein group 1 ineffective orifice area (EOA) (p=0.002), regurgitant volume (RV) (p=0.005),regurgitant fraction (RF) (p=0.002) and semi-quantitative MR (p=0.002). Therewas also a significant decrease in group 2 in EOA (p=0.002), RV (p=0.001), RF (p=0.001)and semi-quantitative MR (p=0.005) grades after 3 months. However, mitralregurgitation severity was not changed with medical treatment in group 3. .There was no difference between groups when residual MR grades at the third monthwere compared with each other (p>0.05).Our study showedthat percutaneous or surgical revascularization strategies significantlyimproved MR parameters, on the other hand no improvement was obtained withmedical treatment. In spite of the improvement in the severity of MR, therewere still significant residual MR after revascularization strategies withoutvalvular intervention.  For this reasonit can be suggested that revascularization strategies without valvularintervention is effective but not sufficient for the treatment of patients withischemic MR.Key words: Ischemic mitral regurgitation, PISA, revascularization

Keywords

• Ischemic mitral regurgitation, PISA, revascularization

Kaynakça

1. Hickey MS, Smith LR, Muhlbaier LH, et al. Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation 1988; 78: I51-159.
2. Adler DS, Goldman L, O'Neil A, et al. Long-term survival of more than 2,000 patients after coronary artery bypass grafting. Am J Cardiol 1986; 58: 19520
3. Campwala SZ, Bansal RC, Wang N, Razzouk A, Pai RG. Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery. Eur J Cardiothorac Surg 2005; 28: 104Aklog L, Filsoufi F, Flores KQ, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation 2001; 104: 68Harris KM, Sundt TM 3rd, Aeppli D, Sharma R, Barzilai B. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg 2002; 74: 1468-1475.
4. Weyman AE. Principles and Practice of Echocardiography. Philadelphia: Lea & Febiger, 1993: 60
5. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of TwoDimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358-367.
6. Lang RM, Bierig M, Devereux RB, et al. Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-1463.
7. Leor J, Feinberg MS, Vered Z, et al. Effect of thrombolytic therapy on the evolution of significant mitral regurgitation in patients with a first inferior myocardial infarction. J Am Coll Cardiol 1993; 21: 1661-1666.
8. Tenenbaum A, Leor J, Motro M, et al. Improved posterobasal segment function after thrombolysis is associated with decreased incidence of significant mitral regurgitation in a first inferior myocardial infarction. J Am Coll Cardiol 1995; 25: 1558-1563.

9. Balu V, Hershowitz S, Zaki Masud AR, Bhayana JN, Dean DC. Mitral regurgitation in coronary artery disease. Chest 1982; 81: 550-555.
10. Christenson JT, Simonet F, Bloch A, et al. Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not? J Heart Valve Dis 1995; 4: 484-488.
11. Pu M, Thomas JD, Gillinov MA, Griffin BP, Brunken RC. Importance of ischemic and viable myocardium for patients with chronic ischemic mitral regurgitation and left ventricular dysfunction. Am J Cardiol 2003; 92: 862-864.
12. Trichon BH, Glower DD, Shaw LK, et al. Survival after coronary revascularization, with and without mitral valve surgery, in patients with ischemic mitral regurgitation. Circulation 2003; 108: 103-110.