title: Ring annuloplasty in chronic ischemic mitral regurgitation: encouraging early and midterm results.
abstract: Ischemic mitral regurgitation, a complication of myocardial infarction, is associated with a poor prognosis and can result in postinfarction congestive heart failure. The preferred treatment of its chronic form is a matter of debate. Herein, we report the early and midterm results in 44 patients with chronic ischemic mitral regurgitation in whom concomitant mitral ring annuloplasty and coronary revascularization were performed at our hospital. We reviewed their medical records. The patients had grades 3/4 and 4/4 chronic ischemic mitral regurgitation, or grade 2/4 regurgitation with left ventricular dilation and low left ventricular ejection fraction. All received circular, flexible annuloplasty rings. Four patients died during the early postoperative period due to low cardiac output (9.1%). At the last follow-up echocardiographic examinations, performed a mean 13.14 +/- 4.66 months after the surgical procedures (range, 6-22 mo), the 40 surviving patients were found to have significantly reduced left ventricular end-diastolic (P = 0.029) and end-systolic (P < 0.05) diameters and improved New York Heart Association functional class (P = 0). Despite a risk of residual regurgitation, mitral ring annuloplasty appears to be a good treatment alternative in selected patients who have chronic ischemic mitral regurgitation. We discuss the procedure's rate of hospital mortality, and its potentially positive impact on survival.
authors.affiliation: Department of Cardiovascular Surgery, Ozel Avrupa Safak Hastanesi, Gaziosmanpasa, 34080 Istanbul, Turkey. htekumit@yahoo.com
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Tekumit
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Cenal
authors.forename: Kemal
authors.initials: K
authors.lastname: Uzun
authors.forename: Cenk
authors.initials: C
authors.lastname: Tataroglu
authors.forename: Esat
authors.initials: E
authors.lastname: Akinci
mesh_terms: D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000601:surgery
references.citation: J Thorac Cardiovasc Surg. 2001 Dec;122(6):1107-24
references.pmid: 11726886
references.citation: Circulation. 2001 Sep 18;104(12 Suppl 1):I68-75
references.pmid: 11568033
references.citation: Eur J Cardiothorac Surg. 2001 Aug;20(2):276-81
references.pmid: 11463544
references.citation: Ann Thorac Surg. 2006 Mar;81(3):1153-61
references.pmid: 16488757
references.citation: Ann Thorac Surg. 2003 Oct;76(4):1094-100
references.pmid: 14529993
references.citation: Ann Thorac Surg. 2002 Nov;74(5):1468-75
references.pmid: 12440594
references.citation: Ann Thorac Surg. 1999 Aug;68(2):426-30
references.pmid: 10475407
references.citation: J Thorac Cardiovasc Surg. 2003 Jan;125(1):135-43
references.pmid: 12538997
references.citation: Am J Cardiol. 2003 Mar 1;91(5):538-43
references.pmid: 12615256
references.citation: J Thorac Cardiovasc Surg. 2004 Mar;127(3):636-44
references.pmid: 15001891
references.citation: J Thorac Cardiovasc Surg. 2001 Dec;122(6):1125-41
references.pmid: 11726887
references.citation: Ann Intern Med. 1992 Jul 1;117(1):18-24
references.pmid: 1596043
references.citation: Am J Cardiol. 2002 Feb 1;89(3):315-8
references.pmid: 11809433
references.citation: Ann Thorac Surg. 2005 Aug;80(2):570-7
references.pmid: 16039207
references.citation: Chest. 1996 Jan;109(1):35-40
references.pmid: 8549213
references.citation: J Thorac Cardiovasc Surg. 2004 Dec;128(6):916-24
references.pmid: 15573077
references.citation: Ann Thorac Surg. 2005 Feb;79(2):462-70; discussion 462-70
references.pmid: 15680815
references.citation: Ann Thorac Surg. 2004 Jun;77(6):1989-97
references.pmid: 15172252
references.citation: J Thorac Cardiovasc Surg. 1992 Sep;104(3):786-95
references.pmid: 1513167
references.citation: Circulation. 2003 Mar 4;107(8):1135-40
references.pmid: 12615791
references.citation: Circulation. 2003 Jan 21;107(2):279-84
references.pmid: 12538428
references.citation: J Card Surg. 2001 Nov-Dec;16(6):473-83
references.pmid: 11925028