Severe mitral regurgitation after acute myocardial infarction: from clinical cases to treatment

Overview: Severe mitral regurgitation after acute myocardial infarction is rare but very serious with a very high mortality rate despite aggressive treatment. Through 8 clinical cases, our aim was to evaluate the mid-term outcome and review the literature on management. Results: Median age: 65 yo (34-74). Six cases were male, admitted to the hospital with acute myocardial infarction 24-72 hours ago. Clinical progression was very rapid with acute pulmonary edema and cardiogenic shock (6/8 cases). 6 patients underwent emergency surgery for mitral valve replacement (5), mitral valve valvuloplasty (1), and coronary artery bypass grafting (4); 2 patients underwent semi-emergent mitral valve repair. Postoperative period was severe and prolonged with high dose of inotropic drugs and intra-aortic balloon pump. However, 7 cases recovered well and were discharged. One case was operative death. In surgery, complete rupture of the posterio-median papillary muscle accounted for the majority of 6/8 cases. Conclusion: The cause of severe mitral regurgitation after myocardial infarction is mainly due to posterio-median papillary muscle injury. Depending on the clinical manifestations and the conditions of the cardiovascular center, treatment includes a combination of medical treatment, mitral valve surgery and transcatheter mitral valve intervention. Surgical valve replacement or mitral repair gives good results in the medium term.