EDUCATION IN HEART
Valvular heart disease
How to manage ischaemic mitral regurgitation
1 Responsable de l’Unité de Soins Intensifs Cardiologiques, CHU Sart Tilman, Liege, Belgique
2 Department of Cardiology, Princess Alexandra Hospital and University of Queensland School of Medecine, Brisbane, Australia
3 Faculté de Médecine, Université de Liège, Chef de Service, Service de Cardiologie, CHU Sart Tilman, Liege, Belgique
Correspondence to:
Professor Patrizio Lancellotti, Department of Cardiology, University Hospital of Liège, B - 4000 Liege, Belgium; plancellotti@chu.ulg.ac.be
| The first 150 words of the full text of this article appear below. |
Ischaemic heart disease is becoming an increasingly frequent cause of ischaemic mitral regurgitation (IMR). Three different clinical entities of IMR, which deeply affect the clinical decision making, are distinguishable: the acute IMR complicating an acute myocardial infarction, the true IMR secondary to a transient ischaemic phenomenon, and the chronic functional IMR (FIMR). The incidence of the two first entities is low; the third is much more frequent.
ACUTE ISCHAEMIC MITRAL REGURGITATION COMPLICATING THE ACUTE PHASE OF MYOCARDIAL INFARCTION
IMR can occur acutely in patients sustaining an acute myocardial infarction. The rupture of a papillary muscle—most frequently a head of a posteromedial papillary muscle—is a dramatic mechanical complication of acute myocardial infarction, leading to a very high mortality rate in the absence of immediate surgical intervention. Surgery, most often valve replacement, is warranted after stabilisation of the haemodynamic status using an intra-aortic balloon pump and vasodilators.1 In the absence of such a rupture, the presence of IMR in the
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