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Eur J Cardiothorac Surg 2005;28:778-779
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Raja

Divisions of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA

Received 3 August 2005; accepted 5 August 2005.

^_* Corresponding author. Division of Cardiology, University of Southern California, 1510 San Pablo Street, 322, Los Angeles, CA 90033, USA. Tel.: +1 323 442 6131; fax: +1 323 442 6133. (Email: rpai{at}usc.edu).

Key Words: Coronary artery bypass surgery • Mitral regurgitation • Coronary artery disease

We want to thank Dr Raja for his interest in our paper [1]. The main message of our paper is that 3 or 4 + MR regression in the setting of ischemic cardiomyopathy depends upon LV size reduction following CABG. This depends on presence of adequate viable myocardium and its revascularization. Medical therapy that facilitates reverse remodeling of the LV is helpful as well. Though, our study gives insights into MR regression, we are not recommending leaving 3–4 + MR alone during CABG. As genesis and progression of ischemic MR depends on LV remodeling, we suggest that in addition to mitral valve repair, these patients need aggressive revascularization and therapy with beta blockers and ACEI inhibitors for the mitral valve repair to be durable.

Coming to the important question of the handling of 2 + MR during CABG, clearly no consensus exists. However, the results of our study may be cautiously extrapolated to this group of patients. We feel that whether or not mitral valve is surgically addressed, aggressive myocardial revascularization and medical therapy with beta-blockers and ACE inhibitors may help in causing MR regression.

One other practical point we would like to highlight is that MR regression is less likely to occur in those with clinical markers of excessive diffuse atheroscelortic diseases like older age, diabetes mellitus, renal insufficiency and cerebrovascular accident. Patients on cardio-protective medications like beta-blocker and ace-inhibitors prior to CABG may be protected from peri-operative ischemia and benefit from reverse LV remodeling.

References

1. Campwala SZ, Bansal RC, Wang N, Razzouk A, Pai RG. Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery. Eur J Cardiothorac Surg 2005;28:104-108.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Campwala, S. Z. Articles by Pai, R. G. Search for Related Content PubMed Articles by Campwala, S. Z. Articles by Pai, R. G. Related Collections Coronary disease Valve disease