Mitral regurgitation following acute myocardial infarction

Abstract

Mitral valve regurgitation (MR) is a frequent Doppler echocardiographic finding in patients after acute myocardial infarction (AMI) and an independent predictor of long-term cardiovascular mortality. Reported risk factors include advanced age, prior myocardial infarction, infarct extension, and recurrent ischemia. During the early phase of AMI, transient ischemic MR is common and rarely causes hemodynamic compromise. However, when several chordae tendineae or a papillary muscle ruptures, acute left atrial and ventricular volume overload ensues, leading to abrupt hemodynamic deterioration with cardiogenic shock. Auscultation may be unrevealing due to decreased turbulence. Hence, the importance of a high index of suspicion for acute MR in any patient with acute pulmonary edema in the setting of AMI, especially if left ventricular systolic function is well preserved. Later, ventricular remodeling may lead to MR through annular dilatation or papillary muscle migration with malcoaptation of the leaflets. The widespread availability, ease of use and non-invasive nature of Doppler echocardiography have made it the standard diagnostic tool for detecting MR. Mechanical reperfusion of the infarct-related artery seems to be superior to fibrinolysis in decreasing its incidence acutely and in the long run. Nevertheless, when acute severe MR occurs, unless rapidly diagnosed and treated, this dreaded complication is associated with high morbidity and mortality. Prompt surgical intervention after hemodynamic stabilization is essential to ensure a good short-term and long-term prognosis. This review discusses the incidence, long-term prognosis, associated risk factors, complex pathophysiology, time of occurrence, clinical manifestations, diagnosis, and management of patients with MR after AMI.

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

“…Surgical treatment is always considered in complications of the acute myocardial infarction evolving with hemodynamic instability, such as interventricular communication 238 and mitral insufficiency due to rupture or dysfunction of the papillary muscle 239 . Table - Under these conditions, surgery must be performed urgently, and it is important to have the best possible stabilization during the preparation, including the support from an IAB (intraaortic balloon).…”

Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches☆

“…CIMR is not only common, but it also significantly affects prognosis. CIMR occurs in approximately 20-25% of patients followed up after myocardial infarction (MI) [1][2][3][4][5] and in 50% of those with post-infarct congestive heart failure (CHF) [6]. In patients with CHF, even a mild degree of mitral regurgitation (MR) adversely affects survival.…”

Ischemic Mitral Regurgitation on the Threshold of a Solution

“…"Functional MR" broadly denotes abnormal function of normal leaflets in the context of impaired ventricular function; it typically occurs in globally dilated and hypokinetic ventricles or with segmental damage that affects valve closure ( Figure 2). It occurs in roughly 20% to 25% of patients followed up after MI 3,4,10,11 and 50% of those with congestive heart failure. 12 It differs from the dramatic presentation of ruptured papillary muscle (PM), 13 a surgical emergency.…”