Clinical case study: combined surgical treatment of ischemic mitral regurgitation

Abstract

Relevance. An active study of ischemic mitral regurgitation and a modern aggressive approach to its surgical treatment in combination with continuous improvement of plastic valve-retaining methods make the surgical treatment of ischemic mitral regurgitation the most promising, however, the choice of optimal surgical tactics for this pathology continues to be discussed. Objective. The clinical case of combined surgical treatment of severe ischemic mitral regurgitation (plication of the anterolateral commissure by pulling the prolapsing segment of AML (А1), suturing and reimplantation of the ruptured marginal chordae and annuloplasty with the rigid complete annuloplasty ring), formed on the background of progressive ischemic heart disease after myocardial infarction, in combination with CABG (autovenous coronary artery bypass grafting of right coronary artery, posterolateral branch and obtuse marginal branch and mammary coronary artery bypass grafting of diagonal branch). Conclusion. The presence of a «classic» dilatation of the fibrous ring of the mitral valve and an ischemic damage of the leaflets and subvalvular structures (tearing of the chords with impaired coaptation of the leaflets, malfunctioning of the papillary muscles) requires plastic correction of these defects in addition to «classic» annuloplasty of the fibrous ring of the mitral valve, which results to the absence of residual and recurrent mitral regurgitation in the immediate postoperative period.