1. Terminology Functional MR Ischemic MR Associated MR Organic MR
Structural ischemic MR

2. Functional MR Functional MR
: defined as a disorder of regional or global left ventricular remodeling in which anatomically normal leaflets fail to coapt adequately

3. Chronic Ischemic MR
defined as MR occurring more than one week after MI
with (1) one or more left ventricular segmental wall motion abnormalities
(2) significant coronary artery disease in the territory supplying the wall motion abnormality
(3) structurally normal mitral valve leaflets and chordae tendineae.
Ann Thorac Surg. 2006;81:1153–1161.

4. Issues in chronic IMR Repair vs Replacement Repair technique
: down sized ring annuloplaty
: partial vs complete ring annuloplasty
: flexible vs rigid ring annuloplaty
Recurrent MR after repair
Subvalvular or subannular repair
: secondary chordal cutting
: chordal translocation
: papillary muscle sling
: posterior PM relocation
: posterior leaflet extension
: intraventricular PM imbrication

5. Secondary chordal cutting
Messas E et al. Circulation. 2003;108:II-111-II-115.)

6. Chordal translocation

7. Papillary muscle sling
Hvass U et al. Ann Thorac Surg. 2003;75:809-11

8. Intraventricular Papillary muscle imbrication
Menicanti L et al. J Thorac Cardiovasc Surg 2002;123:

9. Posterior PM relocation
Kron IL et al. Ann Thorac Surg. 2002;74:600-1

10. Papillary muscle reposition - Ring plus string -
Langer F et al. J Thorac Cardiovasc Surg 2007;133:247-9

11. Infarct plication
Liel-Cohen N et al. Circulation 2000;101:

12. Patch placement and balloon inflation over infarct region
Hung J et al. Circulation 2002;106:

13. Posterior leaflet extension for IIIb MR

14. 질문 Ischemic MR의 정의에 맞는가? : ischemic MR과 associated MR이 같이 있는 것은 아니었는가?
Ring annuloplasty를 시행하기 전에는 prolaspe가 없었는가?