[Surgical treatment of postinfarction mitral insufficiency. By the Working Group on Valve Diseases of the French Society of Cardiology].

A multicentre study collected a total of 82 cases of operated post-infarct mitral regurgitation. The patients were mainly men (81%) and could be divided into two quite different categories: the first, acute mitral regurgitation operated before the 21st day, mean age 62 years, 72% postero-inferior infarcts with other complications in 1/3 cases. The mechanism of regurgitation was usually rupture of a papillary muscle. The surgical mortality was high (55%) and secondary mortality was 17%. The second group comprised chronic mitral regurgitation operated after the 21st day with a lower mean age (59 years), the majority (2/3) also having postero-inferior infarcts, the cause of regurgitation being papillary muscle dysfunction rather than rupture. Surgery was much better tolerated with 12% operative mortality and 24% secondary mortality in patients followed up in the long-term. The poor surgical prognosis of the acute forms may be explained by the severity of the lesions and the poor clinical condition of the patients which does not allow postponement of surgery until the chronic phase when the postoperative results approach those of rheumatic valve lesions. The end results in both groups justify this form of surgery associated where possible with coronary revascularisation.