[Ischemic mitral regurgitation : pathomechanisms and current therapeutic options].

Ischemic mitral regurgitation (MR) is a complication of myocardial infarction due to coronary heart disease and may occur during the course of acute ischemia or delayed following adverse left ventricular remodeling. Acute ischemic MR represents a life-threatening condition and requires immediate surgical correction. Chronic ischemic MR develops time-delayed from acute ischemia and is caused by pathological remodeling of the left ventricle or valvular apparatus and mostly affects older patients with severe comorbidities. This common manifestation of ischemic MR contributes to the poor prognosis of such patients. Therapeutic options for the treatment of patients with chronic ischemic MR are limited as current guidelines are based on weak evidence and the optimal treatment is still a matter of controversy. Surgical correction of chronic ischemic MR is only advised in patients with indications for concomitant surgical revascularization and modern interventional or surgical treatment strategies to reduce MR are not included in these guidelines. Modern surgical options and new interventional procedures are available and will influence future treatment strategies of this chronic manifestation of MR.