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International Journal of Clinical Cardiology





DOI: 10.23937/2378-2951/1410025



Functional Mitral Regurgitation Tenting Area is Directly Related to Non-Ischemic Cadiomyopathy

Ovidio A. Garcia-Villarreal*



Department of Cardiac Surgery, Hospital of Cardiology, UMAE 34, IMSS, Mexico


*Corresponding author: Ovidio A. Garcia-Villarreal, Department of Cardiac Surgery, Hospital of Cardiology, UMAE 34, IMSS, Sierra Nayarita 143, Virginia Tafich, 66374, Santa Catarina, Nuevo León, México, Email: ovidiogv@hotmail.com
Int J Clin Cardiol, IJCC-2-025, (Volume 2, Issue 2), Letter to the Editor ; ISSN: 2378-2951
Received: March 01, 2015 | Accepted: March 20, 2015 | Published: March 22, 2015
Citation: Garcia-Villarreal OA. (2015) Functional Mitral Regurgitation Tenting Area is Directly Related to Non-Ischemic Cadiomyopathy. Int J Clin Cardiol 2:025. 10.23937/2378-2951/1410025
Copyright: © 2015 Garcia-Villarreal OA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Letter to the Editor

I have read with great interest the article by Kammoun et al. [1], and I congratulate them for this paper. Functional mitral regurgitation (MR) is a very hard-to-treat illness, because it is not a disease itself but just the final result of an impaired and/or geometrically distorted left ventricle. Agricola et al. [2] have described in a fine way the high impact played by the tethering mechanism of the posterior mitral complex in this kind of patients. Indeed, the functional MR can be caused by two possible mechanisms. First, in dilated cardiomyopathy, a symmetric tethering pattern can be often observed as responsible for MR. Consequently, the tenting area here is large before MR is severe. Second, in chronic ischemic mital regurgitation, an asymmetric tethering pattern is often seen causing mitral regurgitation. In this latest subset of patients, the posterior leaflet angle (PLA) of the mitral valve becomes the most important key in the degree of MR [3]. So, the tenting area is not as important as PLA in the cases of chronic ischemic MR. Magne et al. [4] have shown the importance of PLA in this special group of patients. In conclusion, I suggest that we need to define very clearly that the results found by the authors [1] are more compatible for funcional MR caused by dilated cardiomyopathy. On the other hand, chronic ischemic MR is highly PLA-dependent.


References
  1. Kammoun I, Marrakchi S, Zouari F, Fersi I, Ibn Elhaj Z, et al. (2014) Parameters of mitral deformability in patients with functional mitral regurgitation. Int J Clin Cardiol 1: 008.

  2. Agricola E, Oppizzi M, Maisano F, De Bonis M, Schinkel AF, et al. (2004) Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern. Eur J Echocardiogr 5: 326-334

  3. Garcia-Villarreal OA (2014) The importance of the posterior leaflet angle in chronic ischemic mitral regurgitation. J Thorac Cardiovasc Surg 147: 1717-1718.

  4. Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, et al. (2007) Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation 15:782-791.

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