Patients With Ischemic Mitral Regurgitation Treated With Percutaneous Coronary Intervention




We enjoyed the recent review from the Cleveland Clinic describing outcomes of patients with mitral regurgitation treated with percutaneous coronary intervention (PCI). We first described this technique with a small series from the prestent era in 1987. At that time, most patients had at least 2-vessel disease, and in all cases, mitral valve replacement and surgery were prevented by acute PCI. As the investigators describe, all the patients had single-vessel disease treated, although they did suffer from multivessel disease. Because this procedure can be done more rapidly than the extensive and more expensive surgical repair, it certainly is advisable in many patients presenting with acute ischemic mitral regurgitation and pulmonary edema, as our series included. If a patient presents with this problem on the future with the advent of the percutaneous mitral annuloplasty, perhaps this could be used in concert with that technique.


In patients with ruptured chordae tendineae, obviously this is not an approach that would be used, but perhaps in the future, a combination of PCI and percutaneous annular repair can be used even in this group. In contrast, with the ability to more quickly revascularize patients presenting acutely, perhaps many of these patients will not succumb to structural rupture or other valvular apparatus problems that would make surgery prohibitively risky.


References



  1. 1. Yousefzai R., Bajaj N., Krishnaswamy A., Goel S.S., Agarwal S., Aksoy O., Aggawal B., Duarte V., Anabtawi A., Parashar A., Sodhi N., Thomas J., Griffin B.P., Tuzcu E.M., and Kapadia S.R.: Outcomes of patients with ischemic mitral regurgitation undergoing percutaneous coronary intervention. Am J Cardiol 2014; 114: pp. 1011-1017

  2. 2. Heuser R.R., Maddoux G.L., Goss J.E., Ramo B.W., Raff G.L., and Shadoff N.: Coronary angioplasty for acute mitral regurgitation due to myocardial infarction: a nonsurgical preserving mitral valve integrity. Ann Intern Med 1987; 107: pp. 852-855

  3. 3. James E., Tcheng J.E., Jackman J.D., Nelson C.L., Gardner L.H., Rankin J.S., Califf R.M., and Stack R.S.: Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. Ann Intern Med 1992; 117: pp. 18-24

  4. 4. Lehmann K.G., Francis C.K., Sheehan F.H., and Dodge H.T.: Effect of thrombolysis on acute mitral regurgitation during evolving myocardial infarction. Experience from the Thrombolysis In Myocardial Infarction (TIMI) Trial. J Am Coll Cardiol 1993; 22: pp. 714-719

  5. 5. Lehmann K.G., Francis C.K., and Dodge H.T.: Mitral regurgitation in early myocardial infarction. Incidence, clinical detection, and prognostic implications. TIMI Study Group. Ann Intern Med 1992; 117: pp. 10-17

  6. 6. Piérard L.A., and Lancellotti P.: The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema. N Engl J Med 2004; 351: pp. 1627-1634

  7. 7. Replogle R.L., and Campbell C.D.: Surgery for mitral regurgitation associated with ischemic heart disease. Results and strategies. Circulation 1989; 79: pp. I122-I125

  8. 8. Chevalier P., Burri H., Fahrat F., Cucherat M., Jegaden O., Obadia J.F., Kirkorian G., and Touboul P.: Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation. Eur J Cardiothorac Surg 2004; 26: pp. 330-335

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Nov 30, 2016 | Posted by in CARDIOLOGY | Comments Off on Patients With Ischemic Mitral Regurgitation Treated With Percutaneous Coronary Intervention

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