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Postinfarction Mitral Regurgitation
Darragh Brady, MD; Gerard M. Healy, MD; Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI)
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Ischemic mitral regurgitation (IMR) is common complication of myocardial infarction
            • Acute IMR is secondary to papillary muscle infarction (PMI) and rupture
            • Chronic IMR is due to left ventricular remodeling

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Echocardiographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Chew PG et al: Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg. 8(3):342-59, 2018
                              2. Sandoval Y et al: Contemporary management of ischemic mitral regurgitation: A Review. Am J Med. ePub, 2018
                              3. Uretsky S et al: Use of cardiac magnetic resonance imaging in assessing mitral regurgitation: Current evidence. J Am Coll Cardiol. 71(5):547-63, 2018
                              4. Ávila-Vanzzini N et al: Clinical and echocardiographic factors associated with mitral plasticity in patients with chronic inferior myocardial infarction. Eur Heart J Cardiovasc Imaging. 19(5):508-15, 2018
                              5. Nishimura RA et al: 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 135(25):e1159-95, 2017
                              6. Michler RE et al: Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 374(20):1932-41, 2016
                              7. Nickenig G et al: Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol. 67(25):2927-36, 2016
                              8. Glower DD et al: Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 64(2):172-81, 2014
                              9. O'Gara PT et al: Transcatheter therapies for mitral regurgitation: a professional society overview from the American College of Cardiology, the American Association for Thoracic Surgery, Society for Cardiovascular Angiography and Interventions Foundation, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 63(8):840-52, 2014
                              10. Beaudoin J et al: Late repair of ischemic mitral regurgitation does not prevent left ventricular remodeling: importance of timing for beneficial repair. Circulation. 128(11 Suppl 1):S248-52, 2013
                              11. Chinitz JS et al: Mitral apparatus assessment by delayed enhancement CMR: relative impact of infarct distribution on mitral regurgitation. JACC Cardiovasc Imaging. 6(2):220-34, 2013
                              12. Arnous S et al: Quantification of mitral regurgitation on cardiac computed tomography: comparison with qualitative and quantitative echocardiographic parameters. J Comput Assist Tomogr. 35(5):625-30, 2011
                              13. Flachskampf FA et al: Cardiac imaging after myocardial infarction. Eur Heart J. 32(3):272-83, 2011
                              14. Killeen RP et al: Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies. Eur Radiol. 20(8):1886-95, 2010
                              15. Shanks M et al: Quantitative assessment of mitral regurgitation: comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging. 3(6):694-700, 2010
                              16. Chan KM et al: Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 10:61, 2008
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Definitions

                                      • Ischemic mitral regurgitation (IMR) is common complication of myocardial infarction
                                        • Acute IMR is secondary to papillary muscle infarction (PMI) and rupture
                                        • Chronic IMR is due to left ventricular remodeling

                                    IMAGING

                                    • General Features

                                      • CT Findings

                                        • MR Findings

                                          • Echocardiographic Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          Selected References

                                                          1. Chew PG et al: Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg. 8(3):342-59, 2018
                                                          2. Sandoval Y et al: Contemporary management of ischemic mitral regurgitation: A Review. Am J Med. ePub, 2018
                                                          3. Uretsky S et al: Use of cardiac magnetic resonance imaging in assessing mitral regurgitation: Current evidence. J Am Coll Cardiol. 71(5):547-63, 2018
                                                          4. Ávila-Vanzzini N et al: Clinical and echocardiographic factors associated with mitral plasticity in patients with chronic inferior myocardial infarction. Eur Heart J Cardiovasc Imaging. 19(5):508-15, 2018
                                                          5. Nishimura RA et al: 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 135(25):e1159-95, 2017
                                                          6. Michler RE et al: Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 374(20):1932-41, 2016
                                                          7. Nickenig G et al: Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol. 67(25):2927-36, 2016
                                                          8. Glower DD et al: Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 64(2):172-81, 2014
                                                          9. O'Gara PT et al: Transcatheter therapies for mitral regurgitation: a professional society overview from the American College of Cardiology, the American Association for Thoracic Surgery, Society for Cardiovascular Angiography and Interventions Foundation, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 63(8):840-52, 2014
                                                          10. Beaudoin J et al: Late repair of ischemic mitral regurgitation does not prevent left ventricular remodeling: importance of timing for beneficial repair. Circulation. 128(11 Suppl 1):S248-52, 2013
                                                          11. Chinitz JS et al: Mitral apparatus assessment by delayed enhancement CMR: relative impact of infarct distribution on mitral regurgitation. JACC Cardiovasc Imaging. 6(2):220-34, 2013
                                                          12. Arnous S et al: Quantification of mitral regurgitation on cardiac computed tomography: comparison with qualitative and quantitative echocardiographic parameters. J Comput Assist Tomogr. 35(5):625-30, 2011
                                                          13. Flachskampf FA et al: Cardiac imaging after myocardial infarction. Eur Heart J. 32(3):272-83, 2011
                                                          14. Killeen RP et al: Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies. Eur Radiol. 20(8):1886-95, 2010
                                                          15. Shanks M et al: Quantitative assessment of mitral regurgitation: comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging. 3(6):694-700, 2010
                                                          16. Chan KM et al: Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 10:61, 2008