A Case of Ischemic Cardiomyopathy Showed Postoperative Reverse Remodeling and Disappearance of Mitral Regurgitation Predicted by Late Gadolinium Enhanced MRI

The appropriate surgical management of moderate ischemic mitral regurgitation (MR) at the time of coronary artery bypass graft surgery (CABG) remains controversial. A recent study demonstrated no beneficial effect to add mitral repair on CABG for patients with moderate ischemic MR in terms of survival. The possible reason is that the reverse remodeling resulted in improved mitral valve geometry, increased mitral closing force and substantial reduction of MR without surgical mitral repair. Therefore, preoperative prediction of reverse remodeling would be crucial for decision making for adding MR repair on CABG. A 60-year-old man with ischemic cardiomyopathy was admitted to our hospital by exacerbation of heart failure symptom. Left ventricular dilatation (LVEDV: 190 mL), severe impairment of LV systolic function (LVEF: 14.7%) and moderate MR due to tethering were noted on transthoracic echocardiography. On X-ray coronary angiography, triple vessel disease was demonstrated. On LGE MRI, subendocardial infarction with transmural extent of approximately 50% was revealed in inferior-posterior-lateral wall. We assumed that the reverse remodeling could be expected because amount of scar was not extensive. After performing CABG and cardiac resynchronization therapy, LV volume was substantially decreased and moderate MR was disappeared without surgical mitral repair. This case report suggested the possible utility of preoperative viability assessment using LGE MRI for the prediction of postoperative reverse remodeling and improvement of ischemic MR.