Abstract
The purpose of the clinical demonstration is to present a protocol for the development of tactics for treating patients with ischemic mitral regurgitation (MR).
The article presents a description of three clinical cases of the development of tactics for treating patients with coronary artery disease with ischemic MR based on echocardiographic examination data. When deciding on the need for a combined operation, it is necessary to integrate the data of the whole spectrum of echocardiographic data. Among the analyzed parameters, the most significant are: assessment of the severity of regurgitation, severity and nature of left ventricular (LV) myocardial dysfunction, a study of global and local LV remodeling, the degree and nature of changes in mitral valve apparatus, the presence of a viable myocardium, the dynamic component of regurgitation. These important factors make it possible to determine the mechanism for the development of regurgitation, as well as to predict whether revascularization will lead to successful functional recovery of myocardial function, which in turn will lead to a decrease in MR.
The important prognostic value of the test with nitroglycerin for MR reversibility was shown. It has been convincingly demonstrated that the introduction of tissue Doppler methods in the examination of patients with coronary artery disease with ischemic MR gives important quantitative information about the global and regional myocardial function, and also, which is very important, the papillary muscle function of mitral valve (MV), which is impossible with traditional echocardiography. This allows you to use speed indicators and characteristics of LV myocardial deformity and MV structures to clarify the mechanism of MR formation, as well as to predict the dynamics of ischemic MR after myocardial revascularization, which can significantly help in the development of optimal surgical treatment tactics.
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About the authors
- Yuriy I. Buziashvili, Dr. Med. Sc., Professor, Academician of the Russian Academy of Sciences, Head of Department, ORCID
- Inna V. Koksheneva, Dr. Med. Sc., Senior Researcher, ORCID
- Evgeniy P. Golubev, Cand. Med. Sc., Researcher, ORCID
- Bakht Е. Rustamov, Cand. Med. Sc., Cardiac Surgeon
- Amina I. Maloroeva, Postgraduate
