Cirugía de la insuficiencia mitral isquémica funcional

Functional ischemic mitral regurgitation represents a complex valvular lesion with different anatomical types, depending on left ventricular dysfunction, extension of the myocardial damage, changes of left ventricular morphology, or the spatial displacement suffered by the different components of the mitral valve. Currently, it is generally accepted that moderate and severe ischemic mitral regurgitation must be surgically corrected, since the non-corrected lesions entail a poor prognosis. The classical Carpentier classification of the mitral insufficiency requires some modifications in order to allow a proper categorization of the ischemic mitral regurgitation with its various anatomical forms (type IV: variable mitral valve motion). Valve reconstruction must obtain an adequate valve coaptation by the correction of the symmetric or asymmetric regurgitation, so the surgical technique must be individually selected. The restrictive mitral annuloplasty with a small prosthetic ring (two sizes smaller) allows an optimal valvular coaptation by reducing the annular size, including the intertrigonal distance when is dilated. Recently, new annuloplasty systems have been utilized (asymmetric annuloplasty, intracardiac traction with artificial chordae) which open new surgical alternatives to the treatment of this interesting and no totally well-known valvular insufficiency.