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 trace | No |
| Bypass surgery not indicated for angina but possible | |
| MR severe | Yes |
| MR mild to moderate | |
| History of CHF (or class III) and viable myocardium | Possible yes |
| No or mild symptoms or no viability | Uncertain |
| MR trace | No |
| Bypass surgery not possible | |
| MR severe (ERO ≥20 mm2) | |
| Regurgitant volume ≥50–60 ml, EF >35% and low comorbidity | Possible yes |
| Regurgitant volume <50 ml or EF <30–35% | Uncertain |
| High comorbidity | No |
| MR mild to moderate | No |
| MR trace | No |