Huda Hassan IsmailPrince Sultan Cardiac Center, KSA
Title: Moderate ischemic mitral regurgitation: Is it time to intervene?
Post myocardial infarction approximately 30% to 50% of patients will develop Ischemic Mitral Regurgitation (IMR) which is a result of progressive left ventricular remodeling and dysfunction of the subvalvular apparatus which is associated with poor long-term outcome. MR clearly has a negative impact on survival in patients with coronary artery disease, even in patients with mild to moderate MR. Ischemic Mitral Regurgitation (IMR) poses a challenge for the cardiac surgeon specially in moderate IMR. Patients going for CABG and with transthoracic echo showing an asymptomatic IMR, the indication to intervene or not might not be as straight forward as in severe IMR with an occluded coronary and no other indication for surgery. In IMR other parameters must be taken into consideration specially associated reduced ejection fraction, diffuse coronary artery disease, atrial fibrillation, and tricuspid regurgitation which confounds the decision making. IMR might be adynamic in nature and the degree of MR may depend on the loading conditions which also makes the appropriate surgical options for the patients with IMR, such as whether the valve should be repaired or replaced, and if so, how, whether coronary arteries should be grafted whether atrial fibrillation and tricuspid regurgitation should be treated and whether to use the percutaneous therapies more daunting and patients with moderate IMR are less likely to undergo mitral repair those with severe IMR more likely to undergo replacement and guidelines that influence the mode of therapy and understanding mechanism of regurgitation in IMR the are mostly supported by retrospective studies that are marred with biases.
Conclusion: To answers to these questions only randomized trials will provide clinicians with better treatment strategies and, more importantly patients with improved quality of life and survival and less likelihood to either to develop recurrent MR or progression of the moderate MR.
Huda Hassan Ismail completed his graduation from King Faisal University Medical School. He also completed an OPCAB fellowship at Bristol Heart Institute and a mitral valve and ablation fellowship at the San Rafaele Hospital at Milan University. He pursued a fellowship at the Royal College of Surgeons (Ed), the Arab Board in general surgery, and the King Faisal Specialist Cardiothoracic and Vascular. Currently, he is a consultant adult cardiac surgeon at Prince Sultan Cardiac Center, Riyadh, KSA. He is the head of the Cardiac Surgery Scientific Council at SCFHS and director of the Cardiac Surgery Residency Training Program at Prince Sultan Cardiac Center, Riyadh. He is also the secretary general of the Saudi Cardiac Surgery Society. His research interests are mitral valve surgery, tricuspid valve surgery, ischemic heart disease surgery, and extra-circulatory cardiac surgery.