Ischemic heart disease may result in acquired mitral regurgitation (MR) due to a change in the geometry of the left ventricle. Aklog et al defined moderate ischemic mitral regurgitation based on clinical and echocardiographic features. The authors are from Brigham and Women's Hospital in Boston.


NOTE: The original definition is for moderate disease. I have attempted to modify this to encompass the spectrum of disease.



(1) Evidence of significant symptomatic multivessel coronary artery disease, with or without documented myocardial infarction but the patient should not be actively ischemic.

(2) Absence of mitral stenosis

(3) Type I or Type IIIb using the functional classification of Carpentier et al

(4) Mitral regurgitation by echocardiography or ventriculogram with dye injection (graded 1+ to 4+)

(5) Regurgitant jet to the posterior wall of the left atrium without reversal or blunting of pulmonary venous flow.



• Carpentier Type I = annular dilatation with normal leaflet motion

• Carpentier Type IIIb = restricted leaflet motion during systole.

• The original definition of Aklog et al for moderate ischemic MR specified grade 3+ MR.

• I added an item to indicate that the MR developed following the onset of ischemic heart disease (to separate it from congenital or other forms of MR).


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