Coronary angioplasty for acute mitral regurgitation due to myocardial infarction

When acute severe mitral regurgitation is associated with pulmonary edema in the immediate period after myocardial infarction, the patient must be treated aggressively. Because the papillary muscles are perfused by the terminal portion of the coronary vascular bed, they are particularly vulnerable to ischemia and any disturbance in coronary perfusion such as an acute occlusion of a coronary artery may result in papillary muscle dysfunction [1]. When the ischemia is severe and persistent, papillary muscle necrosis and permanent mitral regurgitation may result. The posterior papillary muscle is supplied by the posterior descending branch of the right coronary artery and is infarcted more frequently than the anterolateral papillary muscle, which is supplied by diagonal branches of the left anterior descending artery and often by the marginal branches of the circumflex coronary artery [2]. Reperfusion therapy with fibrinolytic agents or coronary angioplasty theoretically could salvage the functional integrity of the mitral valve apparatus without surgery.