Are there indications for reconstructive surgery in severe mitral regurgitation after acute myocardial infarction?

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Abstract
From 1972 to 1988, early surgery were performed in 26 patients withacute mitral regurgitation (MR) unresponsive to medical managementcomplicating a recent acute myocardial infarction (AMI). The indication wasacute pulmonary oedema (11), major left ventricular insufficiency (5),cardiogenic shock (10). Surgery was performed within 3 weeks following AMI.Mitral lesions were as follows: rupture of chordae tendinae (9) ofpapillary muscle (6), haemorrhagic necrosis of one (17) or two (9)papillary muscles. The mitral annulus was never found to be enlarged. TheLV posterior wall was necrotic in 23, with a septal rupture in 3 and agiant aneurysm in 5. Valve replacement was performed in all but onepatient. The 30-day mortality included 8 patients (31%). The cause of deathwas myocardial insufficiency in 5, early thrombosis of a disk valve in 1and unrelated complications in 2. One patient deteriorated rapidly and hada Jarvik device implanted. Late results (1 month-15 years) showed 4 cardiacrelated deaths within the first year. One patient had to be transplantedafter 1 year. Two patients died of non-cardiac problems at 3 months and 5years. The probability of survival at 5 years is 43% and at 10 years 22%.In conclusion, there are still indications for early surgery in MR postAMI. Anatomical lesions of both papillary muscles and ventricular wall donot allow conservative surgery and new non-invasive technics provide a morepromising strategy in such desperately ill patients.

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