Treatment Strategy for Patients with Subacute Myocardial Infarction and Severe Ischemic and Functional Mitral　Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Tiefu , WANG Shengyu , LIU Dong , MA Hanying.

1. Department of Cardiac Surgery，Beijing　Anzhen Hospital，Capital Medical University，Beijing 100029，P. R. China;;
2. Department of Geriatric Cardiology，Beijing　Anzhen Hospital，Capital Medical University，Beijing 100029，P. R. China;

Corresponding author：

Keywords：

Subacute myocardial infarction; Mitral regurgitation; Coronary artery bypass grafting

DOI：

10.7507/1007-4848.20130046

Video：

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Objective To investigate appropriate treatment strategy and timing for patients with subacute myocardial infarction and severe ischemic mitral regurgitation （IMR）. Methods A total of 89 patients with subacute myocardial infarction and severe IMR underwent surgical treatment from January 2005 to December 2011 in Beijing Anzhen Hospital. There were 66 male patients and 23 female patients with their mean age of 64 （55-73） years. All the patients received only coronary artery bypass grafting （CABG） after 3 months of medication treatment without specific management for their IMR. Echocardiography was examined before medication treatment，preoperatively and 6 months after CABG to analyze their IMR degree and measure left ventricular end-systolic dimension （LVESD），left ventricular end diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF）. Results There was no surgery-related death，perioperative myocardial ischemia or other severe postoperative complication. Eighty-one patients （91.0%） were followed up for 6-60 months. At 6 months after CABG，mitral regurgitation area （3.1±1.3 cm2 vs. 5.6±2.3 cm2），LVEDD （51.3±4.2 mm vs. 54.3±5.5 mm） and LVESD （31.7±3.9 mm vs. 34.6±4.3 mm） were significantly decreased than preoperative values （P＜0.05），but LVEF was not statistically different from preoperative value （59.1%±3.9% vs. 58.9%±5.6%，P＞0.05）. From the third year during follow-up，all the patients received annual CT examination of their coronary artery，and no significant graft stenosis （graft stenosis＞50%） was found. Conclusion With appropriately delayed CABG and right medication treatment，patients with subacute myocardial infarction and severe IMR may no longer need concomitant surgical management for their IMR， which can decrease surgical risks and reduce treatment cost.

Citation： ZHAO Tiefu,WANG Shengyu,LIU Dong,MA Hanying.. Treatment Strategy for Patients with Subacute Myocardial Infarction and Severe Ischemic and Functional Mitral　Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 144-147. doi: 10.7507/1007-4848.20130046 Copy

1.	Paparella D， Malvindi PG， Romito R， et al. Ischemic mitral regurgitation：pat hophysiology， diagnosis and surgical treatment. Expert Rev Cardiovasc Ther， 2006， 4 （6）：827-838.
2.	Raja SG， Berg GA. Moderate ischemic mitral regurgitation：to treat or not to treat. J Card Surg， 2007， 22 （4）：362-369.
3.	Edmunds JL， Chief Editor. Cardiac Surgery in the Adult. New York：Mcgrawhill， 1997. 657-658.
4.	李京倖，顾承雄，韦华，等. 心功能不全冠心病患者非体外循环冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志， 2011， 18 （2）：157-159.
5.	徐明，陈绪军，陈鑫，等. 巨大左心室而无室壁瘤冠心病患者行冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志， 2011， 18 （2）：117-120.
6.	张炬倩，李晨，饶莉，等. 缺血性二尖瓣反流的机制，诊断和治疗研究进展. 心血管病学进展， 2009， 30 （6）：919-922.
7.	吴若彬，郑少忆，郭惠明，等. 冠心病合并缺血性二尖瓣关闭不全的处理方法. 中华胸心血管外科杂志， 2004， 20 （5）：271-273.
8.	喻磊，谷天祥，师恩祎，等. ≥70岁与＜70岁瓣膜病合并冠心病患者的外科治疗. 中国胸心血管外科临床杂志， 2010， 17 （3）：192-197.
9.	郑居兵，屈正，李扬. 45岁以下冠心病患者的外科治疗. 中国胸心血管外科临床杂志， 2010， 17 （3）：242-243.
10.	邱志兵，陈鑫，徐明，等. IABP辅助下非体外循环冠状动脉旁路移植术治疗冠心病合并严重左心室功能不全. 中国胸心血管外科临床杂志， 2009， 16 （6）：488-490.
11.	Duarte IG， Shen Y， Macdonald MJ， et al. Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone：late results. Ann Thorac Surg， 1999， 68 （2）：426-430.
12.	Edmundslh JR， Lh Jr， Chief Editor. Cardiac Surgery in the Adult. New York：McGraw-Hill， 1997.657-676.
13.	麦明杰，陈星权，郑少忆，等. 冠心病合并重度缺血性二尖瓣关闭不全的外科治疗早期疗效分析. 南方医科大学学报， 2011， 31 （6）：1072-1074.
14.	鲍春荣，梅举，王宜青，等. 冠心病伴缺血性二尖瓣关闭不全27例手术治疗分析. 上海交通大学学报：医学版， 2008， 28 （3）：326-328.
15.	Chiappini B， Minuti U， Gregorini R， et al. Early and long-term outcome of mitral valve repair with a Cosgrove band combined with coronary revascularization in patients with ischemic cardiomyopathy and moderate-severe mitral regurgitation. J Heart Valve Dis， 2008， 17 （4）：396-401.
16.	He S， Fontaine AA， Schwammenthal E， et al. Integrated mechanism for functional mitral regurgitation：leaflet restriction versus coapting force：in vitro studies. Circulation， 1997， 96 （6）：1826-1834.
17.	He GW， Hughes CF， Mccaughan B， et al. Mitral valve replacement combined with coronary artery operation：determinants of early and late results. Ann Thorac Surg， 1991， 51 （6）：916-922.
18.	陈鑫，徐明，蒋英硕. 同期心脏瓣膜手术与冠状动脉旁路移植术81例. 中国胸心血管外科临床杂志， 2006， 13 （3）：158-161.
19.	Tolisga JR， Korkolis DP， Kopf GS， et al. Revascularization alone （without mitral valve repair）suffices in patients with advanced ischemic cardiomyopathy and mild-to-moderate mitral regurgitation. Ann Thorac Surg， 2002， 74 （5）：1476-1478.

1. 　Paparella D， Malvindi PG， Romito R， et al. Ischemic mitral regurgitation：pat hophysiology， diagnosis and surgical treatment. Expert Rev Cardiovasc Ther， 2006， 4 （6）：827-838.
2. 　Raja SG， Berg GA. Moderate ischemic mitral regurgitation：to treat or not to treat. J Card Surg， 2007， 22 （4）：362-369.
3. 　Edmunds JL， Chief Editor. Cardiac Surgery in the Adult. New York：Mcgrawhill， 1997. 657-658.
4. 　李京倖，顾承雄，韦华，等. 心功能不全冠心病患者非体外循环冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志， 2011， 18 （2）：157-159.
5. 　徐明，陈绪军，陈鑫，等. 巨大左心室而无室壁瘤冠心病患者行冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志， 2011， 18 （2）：117-120.
6. 　张炬倩，李晨，饶莉，等. 缺血性二尖瓣反流的机制，诊断和治疗研究进展. 心血管病学进展， 2009， 30 （6）：919-922.
7. 　吴若彬，郑少忆，郭惠明，等. 冠心病合并缺血性二尖瓣关闭不全的处理方法. 中华胸心血管外科杂志， 2004， 20 （5）：271-273.
8. 　喻磊，谷天祥，师恩祎，等. ≥70岁与＜70岁瓣膜病合并冠心病患者的外科治疗. 中国胸心血管外科临床杂志， 2010， 17 （3）：192-197.
9. 　郑居兵，屈正，李扬. 45岁以下冠心病患者的外科治疗. 中国胸心血管外科临床杂志， 2010， 17 （3）：242-243.
10. 　邱志兵，陈鑫，徐明，等. IABP辅助下非体外循环冠状动脉旁路移植术治疗冠心病合并严重左心室功能不全. 中国胸心血管外科临床杂志， 2009， 16 （6）：488-490.
11. 　Duarte IG， Shen Y， Macdonald MJ， et al. Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone：late results. Ann Thorac Surg， 1999， 68 （2）：426-430.
12. 　Edmundslh JR， Lh Jr， Chief Editor. Cardiac Surgery in the Adult. New York：McGraw-Hill， 1997.657-676.
13. 　麦明杰，陈星权，郑少忆，等. 冠心病合并重度缺血性二尖瓣关闭不全的外科治疗早期疗效分析. 南方医科大学学报， 2011， 31 （6）：1072-1074.
14. 　鲍春荣，梅举，王宜青，等. 冠心病伴缺血性二尖瓣关闭不全27例手术治疗分析. 上海交通大学学报：医学版， 2008， 28 （3）：326-328.
15. 　Chiappini B， Minuti U， Gregorini R， et al. Early and long-term outcome of mitral valve repair with a Cosgrove band combined with coronary revascularization in patients with ischemic cardiomyopathy and moderate-severe mitral regurgitation. J Heart Valve Dis， 2008， 17 （4）：396-401.
16. 　He S， Fontaine AA， Schwammenthal E， et al. Integrated mechanism for functional mitral regurgitation：leaflet restriction versus coapting force：in vitro studies. Circulation， 1997， 96 （6）：1826-1834.
17. 　He GW， Hughes CF， Mccaughan B， et al. Mitral valve replacement combined with coronary artery operation：determinants of early and late results. Ann Thorac Surg， 1991， 51 （6）：916-922.
18. 　陈鑫，徐明，蒋英硕. 同期心脏瓣膜手术与冠状动脉旁路移植术81例. 中国胸心血管外科临床杂志， 2006， 13 （3）：158-161.
19. 　Tolisga JR， Korkolis DP， Kopf GS， et al. Revascularization alone （without mitral valve repair）suffices in patients with advanced ischemic cardiomyopathy and mild-to-moderate mitral regurgitation. Ann Thorac Surg， 2002， 74 （5）：1476-1478.

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Treatment Strategy for Patients with Subacute Myocardial Infarction and Severe Ischemic and Functional Mitral　Regurgitation

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment Strategy for Patients with Subacute Myocardial Infarction and Severe Ischemic and Functional Mitral Regurgitation

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Treatment Strategy for Patients with Subacute Myocardial Infarction and Severe Ischemic and Functional Mitral　Regurgitation