الفهرس 
Definition & prevalence of IMROnly 14 pages are availabe for public view
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Abstract
Background: chronic ischemic mitral regurgitation (IMR) is a common complication of myocardial infarction and severely affects cardiovascular mortality and morbidity. There is a debate regarding optimal surgical management of moderate degree mitral regurgitation. Aim of the study: The purpose of this study is to determine whether the optimal surgical management of moderate IMR is to revascularize only or to revascularize combined with mitral valve surgery. Subjects and methods: 100 patients with IHD and associated Ischemic Mitral Regurgitation undergoing CABG were included in the study. Study population: Two groups according to mitral valve intervention: group A: 50 Patients with IMR who were subjected for complete revascularization without mitral valve surgery. group B: 50 patients who were subjected for revascularization with mitral valve surgery. All patients were evaluated thoroughly preoperative, intra-operative, and post-operative. The study was done at the Cardio-vascular Surgery Academy, Ain Shams University, and Shebeen El-koom Teaching Hospital. Results: There were 31 (62%) males and 19 (38%) females in group (A) as compared to 38 (76%) males and 12 (24%) females in group (B) (p=NS). The mean age for group (A) was 59.6 ±5.9 and for group (B) 57.7±8.5 (p=NS). No significant differences between the two groups regarding risk factors pre-operatively except the difference in previous MI which was recorded more in group B patients(43 versus 32 in group A) (p=0.02). There was highly significant difference as regards the total bypass time, 72.2 ± 17.6 in group A and 113.5±14.3 in group B(p<0.001), ischemic time, 47.4 ± 12.1 in group A and 79.7 ± 12.3 in group B(p<0.001), mechanical ventilation, 10.9±14.9 in group A versus 14.9 ±12.1 in group B (p<0.001), the total period of ICU stay, 46.1± 21.2 in group A versus 63.7 ±22.2 in group B(p<0.001) and the ward stay, 5.7±2.3 versus 6.8 ±2.9 in group B(p<0.001). The need for inotropic support, showed significant difference between the two groups, 20 (40%) in group A versus 36 (72%) in group B (p=0.001). There was no significant difference between the two groups in the use of IABP, 5 (10%) in group A versus 13(26%) in group B. There was an improvement in the EF in both groups at one week and one month follow up echocardiography. Also, we assessed the patient’s LVEDD, LVESD and LA size which all showed improvement. In group A; percentage of patients with grade 3+ mitral regurgitation appeared in 15.6% of patients at one month follow up and in group B; grade 2+ reappeared in 21.7% of patients at one month follow up. Dyspnea improved in both groups in the follow up period, in group A; 41 patients had dyspnea NYHA class I and 4 patients had NYHA class II while in group B, all living patients had improved dyspnea to NYHA class I. This was statistically significant (p=0.01). Conclusion and recommendations: The addition of mitral-valve surgery to CABG resulted in longer durations of cardiopulmonary bypass and aortic cross-clamping and longer stays after surgery in the ICU and the ward. The longer operation may predispose to more complications. Mitral valve replacement remains a viable option for the treatment of IMR with no reappearance of MR at follow up. NYHA class improved in both management modalities.