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European Journal of Echocardiography 2004 5(5):313-317; doi:10.1016/j.euje.2004.07.001
© 2004 by European Society of Cardiology
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Copyright © 2004, The European Society of Cardiology

New understanding of ischemic mitral regurgitation: the marionette and its masters*

Robert A. Levinea,*, Emmanuel Messasb, Nadia S. Nathanc and Lawrence G. Rudskid

aCardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, VBK 508 Boston, MA, USA
bHopital Europeen Georges Pompidou, Faculty of Medicine Necker-Enfants Malades, Paris, France
cDivision of Anesthesia, Brigham & Womens Hospital, Harvard Medical School, Boston, MA, USA
dDivision of Cardiology, Sir Mortimer B. Davis—Jewish General Hospital, McGill University, Montreal, Quebec, Canada

* Corresponding author. Tel.: +1 617 724 1995; fax: +1 617 726 8383. rlevine@partners.org

The first 10% of the full text of this article appears below.

Please see page 326 for the article by Agricola et al. (doi:10.1016/j.euje.2004.03.001) to which this editorial pertains.

Echocardiographic observations of leaflet motion have taught us volumes about the mechanism of valvular heart disease. Identifying excessive versus restricted mitral leaflet motion, as in Carpentier's classification, has become the foundation of repair techniques tailored to the individual patient.1 Ischemic mitral regurgitation (MR) has nevertheless remained a therapeutic challenge,2–6 with important failure and recurrence rates after standard annular ring reduction,7,8 and a higher peri-operative mortality than with degenerative MR.2–5 In ischemic MR as well, echocardiography has firmly established that restricted leaflet motion is the fundamental mechanism in the vast majority of patients,9,10 confirming the proposal that displacement of the papillary muscles (PMs) in the remodeling heart tethers the leaflets into the ventricular cavity.11–17 Echocardiography has provided further mechanistic clues: the anterior . . . [Full Text of this Article]


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Related articles in Eur J Echocardiogr:

Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern
Eustachio Agricola, Michele Oppizzi, Francesco Maisano, Michele De Bonis, Arend F.L. Schinkel, Lucia Torracca, Alberto Margonato, Giulio Melisurgo, and Ottavio Alfieri
Eur J Echocardiogr 2004 5: 326-334. [Abstract] [FREE Full Text]  



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