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2015 The American Association for Thoracic Surgery Consensus Guidelines: Ischemic mitral valve regurgitation  Irving L. Kron, MD, Michael A. Acker, MD,

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Presentation on theme: "2015 The American Association for Thoracic Surgery Consensus Guidelines: Ischemic mitral valve regurgitation  Irving L. Kron, MD, Michael A. Acker, MD,"— Presentation transcript:

1 2015 The American Association for Thoracic Surgery Consensus Guidelines: Ischemic mitral valve regurgitation  Irving L. Kron, MD, Michael A. Acker, MD, David H. Adams, MD, Gorav Ailawadi, MD, Steven F. Bolling, MD, Judy W. Hung, MD, D. Scott Lim, MD, Damien J. LaPar, MD, Michael J. Mack, MD, Patrick T. O'Gara, MD, Michael K. Parides, PhD, John D. Puskas, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 151, Issue 4, Pages (April 2016) DOI: /j.jtcvs Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Schema used to guide the grading of available published evidence and the expected effect of the intervention for their impact on patient outcomes. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Illustrated mechanism of IMR. Apically displaced leaflet coaptation with restricted leaflet closure results in MR. MR, Mitral regurgitation; AoV, aortic valve. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 TTE demonstrating reduced mitral leaflet coaptation in the annular plane, resulting in incomplete leaflet closure and MR. LV, Left ventricle; LA, left atrium; MR, mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 TTE demonstrating decreased surface area of the posterior leaflet relative to the anterior leaflet and tethering of the posterior leaflet, resulting in asymmetric tethering and coaptation with an eccentrically directed mitral regurgitant jet. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 TTE demonstrating tethering of the basal or strut chordae that can result in a bend in the body of the anterior leaflet, further contributing to mitral leaflet tethering and impaired coaptation. LV, Left ventricle; LA, left atrium. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 Measurement of tenting volume used in 3D echocardiography. AO, Aorta; AL, anterolateral; PMs, papillary muscles. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

8 Figure 7 TTE demonstrating LV remodeling as a result of IMR with segmental LV remodeling and inferior wall basal aneurysm formation as well as diffuse LV remodeling. LV, Left ventricle. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

9 Figure 8 Measurement of distal jet area by Doppler echocardiography. PISA, Proximal isovelocity surface area; VC, vena contracta. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

10 Figure 9 Measurement of the VC in an apical long-axis view by TTE. LV, Left ventricle. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

11 Figure 10 Calculation of MV EROA using the PISA method. EROA, Effective regurgitant orifice area; MR, mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

12 Mechanism of ischemic mitral regurgitation: apical displacement of leaflet coaptation with restricted leaflet closure and resultant regurgitation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

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