Timing of surgery in ischaemic mitral regurgitation

Prompt mitral surgery decision
CHF, congestive heart failure; EF, ejection fraction; ERO, effective regurgitant orifice; MR, mitral regurgitation.
Ruptured papillary muscle Yes
Functional mitral regurgitation
Bypass surgery indicated for angina
    MR severe (ERO ≥ 20 mm2)Yes
    MR mild or moderate (ERO < 20 mm2)Possible yes
    MR traceNo
Bypass surgery not indicated for angina but possible
    MR severeYes
    MR mild to moderate
        History of CHF (or class III) and viable myocardiumPossible yes
        No or mild symptoms or no viabilityUncertain
    MR traceNo
Bypass surgery not possible
    MR severe (ERO ≥20 mm2)
        Regurgitant volume ≥50–60 ml, EF >35% and low comorbidityPossible yes
        Regurgitant volume <50 ml or EF <30–35%Uncertain
        High comorbidityNo
    MR mild to moderateNo
    MR traceNo