Post-infarct mitral insufficiency: when to resort to reparative surgery, when to the mitral clip

. 2022 Nov 12;24(Suppl I):I104-I110.

doi: 10.1093/eurheartjsupp/suac082.

eCollection 2022 Nov.


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Juan Carlos Gomez-Polo et al.

Eur Heart J Suppl.



Severe mitral insufficiency is a feared complication that develops in 10-12% of patients with myocardial infarction and ST elevation. It results from the rupture of the papillary muscle or is secondary to an acute remodelling of the left ventricle in its entirety or of the infarcted region. The mortality of patients with acute clinical onset reaches 50%. The ideal treatment of acute mitral insufficiency is controversial and still a source of debate. Most of these patients are at high surgical risk or inoperable; therefore, they are treated conservatively and have a poor prognosis. In these candidates, percutaneous treatment of insufficiency with percutaneous edge to edge can be considered an alternative.


Acute pulmonary oedema; Cardiac surgery; Cardiogenic shock; Ischaemic mitral insufficiency; Percutaneous mitral plastic.

Conflict of interest statement

Conflict of interest: None declared.


Figure 1

(A) Chest X-ray demonstrating acute pulmonary oedema. (B) Transesophageal (midesophageal long axis) echocardiography showing posterior mitral flap prolapse due to posteromedial papillary muscle rupture, generating severe eccentric mitral regurgitation (quantitative method). (C) Coronary Angiography. Right coronary artery in the left anterior oblique view, showing moderate stenosis in the middle segment and critical lesion in the distal segment with TIMI III flow. IABP positioned in the descending thoracic aorta. (D and E) 2D transesophageal echocardiography (two midesophageal chambers) and 3D echocardiography, showing the result after percutaneous edge-to-edge mitral valve repair with mild mitral regurgitation. (F) Mean mitral gradient after Mitraclip implantation.

Figure 2

Figure 2

Decision algorithm in patients with post-acute myocardial infarction acute MI. SCA, acute coronary syndrome; MR, mitral regurgitation; AMI, acute myocardial infarction; TTE, transthoracic echocardiography; LVEF, left ventricular ejection fraction; RV, right ventricle; TEE, transesophageal echocardiography; PMR, rupture of the papillary muscle; SC, heart failure; MCS, mechanical circulatory support; ECMO, extracorporeal membrane oxygenation; IABP, aortic contropulsator; TEER, edge-to-edge transcatheter repair.


    1. Sannino A, Grayburn PA. Ischemic mitral regurgitation after acute myocardial infarction in the percutaneous coronary intervention era. Circ Cardiovasc Imaging 2016;9:e005323.


    1. Mentias A, Raza MQ, Barakat AF, Hill E, Youssef D, Krishnaswamy A, Desai MY, Griffin B, Ellis S, Menon V, Tuzcu EM, Kapadia SR. Prognostic significance of ischemic mitral regurgitation on outcomes in acute ST-elevation myocardial infarction managed by primary percutaneous coronary intervention. Am J Cardiol 2017;119:20–26.


    1. Nishino S, Watanabe N, Kimura T, Enriquez-Sarano M, Nakama T, Furugen M, Koiwaya H, Ashikaga K, Kuriyama N, Shibata Y. The course of ischemic mitral regurgitation in acute myocardial infarction after primary percutaneous coronary intervention: from emergency room to long-term follow-up. Circ Cardiovasc Imaging 2016;9:e004841.


    1. Pahuja M, Singh M, Patel Aet al. . Utilization of mechanical circulatory support devices in chordae tendinae and papillary muscle rupture complicating ST-elevation myocardial infarction: insights from nationwide inpatient sample. J Am Coll Cardiol 2018;71:A219.

    1. Vandenbriele C, Balthazar T, Wilson Jet al. . Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support. Eur Heart J 2020;41:ehaa946.

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