الفهرس 
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Abstract
Ischemic mitral regurgitation is a common clinical problem of coronary artery disease, developing acutely after myocardial infarction in up to 19 % of patients. It may be chronic condition being found approximately in 3 % of patients undergoing coronary angiography, or may less commonly occur as a regional episode of ischemia.
It is defined as mitral regurgitation occurring more than one week after myocardial infarction (MI) accompanied with (1) one or more left ventricular segmental wall motion abnormalities (2) significant coronary disease in territory supplying segment having wall motion abnormality (3) Structurally-normal mitral valve components (annulus, leaflets, and chordate tendinae). Main mechanism leading to its occurrence is apical displacement of mitral valve’s papillary muscles, as this leads to tethering of its secondary chordate with consequently-decreases leaflet coaptation. This process occurs as a result of left ventricular remodeling.
Different studies have demonstrated that ischemic mitral regurgitation is associated with a high one-year mortalitywhich correlates well according to severity or degree of mitral regurgitation.
Although some patients may be asymptomatic, others may present with symptoms of myocardial ischemia or heart failure which varies according to degree of mitral regurgitation and left ventricular dysfunction.
primary purpose of preoperative studies is to determine severity of coronary arterial disease with its anatomy, severity of IMR, degree of left ventricular dysfunction, as well as potential for LV functions to improve following procedure of myocardial re-vascularization.
proper management for concomitant ischemic mitral regurgitation (IMR) at time of coronary artery bypass grafting (CABG) in absence of structural mitral valve disease remains controversial. However, for two extremes of severity, there is little controversy. Almost all authors agree to fact that for mild IMR or less, CABG is usually sufficient; whereas for severe IMR, corrective surgical procedure has to deal specifically with valvular pathology. However, for moderate IMR, optimal management policy is stilldebated.
In this study, we comparatively-studied postoperative follow-up course of repaired versus unrepaired moderate ischemic mitral regurgitation following CABG surgery in order to assess their effect on immediate, midterm (6 months), and late (one year) postoperative periods. Another goal was to identify factors which could predict regression/improvement of this moderate IMR with each management policy.
Between July 2018 to January 2023, a study of eighty patients with ischemic heart disease associated with moderate chronic ischemic mitral regurgitation. Study was carried out in department of cardiac surgery and other multicenter after obtaining approval of local ethical committee and a fully-informed written consent from each patient. All patients had CAD with moderate IMR. Patients admitted for CABG combined with mitral repair versus CABG alone.
After our study evaluation, we found that patients who were offered combined approach of CABG with repair, showed more improvement as to clinical and echocardiographic parameters, compared to those who were offered CABG alone procedure. We also found that a worse preoperative LV function is reason that leads to persistence or progression of IMR pathology towards severer grades in CABG only patients.