Ischemic mitral regurgitation, the dynamic lesion: clues to the cure.

Functional ischemic mitral regurgitation (MR) is now receiving increased attention as one of the last frontiers in mitral valve repair as well as a therapeutic opportunity in heart failure (1–5). Valve repair has proved more challenging for ischemic MR than for degenerative mitral valve prolapse, in which surgery is tailored to the detailed anatomy displayed by echocardiography and inspection. Successful valve repair must target the mechanism of dysfunction in the individual patient; to date, however, both understanding of mechanism and targeting of therapy have been elusive for ischemic MR (6–9).