Clinically suspected severe ischaemia-induced mitral regurgitation. Spectrum of lesions and features of high surgical risk by echocardiography.

Eighteen patients with clinical signs suggesting severe mitral regurgitation secondary to ischaemic heart disease were assessed by echocardiography. Non-ischaemic diseases needing specific therapy were revealed in six patients. In the other 12 patients echocardiography demonstrated myocardial lesions explaining the mitral regurgitation. Apart from the distinction between non-ischaemic conditions and lesions induced by ischaemia, echocardiography seems to be helpful in the demonstration of severe yet operable mitral valve regurgitation due to a small ischaemic lesion. Such cases are opposed to functional mitral regurgitation caused by extensive myocardial injury as demonstrated by two-dimensional echocardiography and reflected by a minimum mitral valve/septum separation of more than 2 1/2 cm on the M-mode echocardiogram. These conditions make symptomatic improvement by mitral valve surgery unlikely and carry an extremely high operative mortality. A more precise definition by heart catheterization is required when serious clinical heart failure is not explained by the echocardiographic finding of severe global myocardial impairment.