Ischemic Mitral Regurgitation: A Multifaceted Syndrome with Evolving Therapies

Figures

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  Figure 1. The two main different phenotypes of ischemic mitral regurgitation (IMR): on the left, left ventricle (LV) is globally dilated, displacement of papillary muscles (PMs) is symmetrical, leading to symmetric systolic tethering of mitral valve (MV) leaflets; on the right, inferior-posterior acute myocardial infarction (AMI) causes asymmetric tethering of MV leaflets with an excessive systolic restriction of posterior MV leaflet.

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  Figure 2. Transesophageal echocardiogram (TEE); (A): IMR with symmetric tethering characterized by central jet of regurgitation in a globally dilated left ventricle with increased mitral annulus diameter. On the left, coaptation depth (CD) may be identified as the distance between the coaptation and the annular plane; on the right, mitral valve tenting area (MVTa) is seen as the space confined between valve leaflets and annular plane. (B): IMR with asymmetric tethering of mitral valve leaflets, more accentuated for posterior mitral leaflet (PML), the white arrows highlight the eccentric jet of mitral regurgitation in the presence of a left ventricle which is not globally dilated.

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  Figure 3. MitraClip implantation with characteristic double-orifice valve at three-dimensional (3D) trans-esophageal echocardiography (TEE).