Impact of papillary muscles approximation on the adequacy of mitral coaptation in functional mitral regurgitation due to dilated cardiomyopathy.
OBJECTIVE
We report early outcome of our modified papillary muscles approximation (PMA) as an adjunct to mitral annuloplasty (MAP) by analyzing the mitral coaptation zone echocardiographically and clinical outcome in three different procedures.


METHODS
Mitral valve coaptation depth (MVCD) and tenting area were measured in patients with ischemic (n=8) or non-ischemic (n=22) dilated cardiomyopathy (ICM or non-ICM) undergoing either of following: Group I: isolated left ventricular volume reduction (LVVR) (n=11), Group II: PMA plus LVVR (n=14), Group III: isolated PMA (n=5). Clinical outcome including cardiac function were also investigated.


RESULTS
Thirty-day mortality was 6.7%. Postoperative data in overall survivors showed significant improvement of ejection fraction (EF) (from 19+/-7 to 32+/-9%), left ventricular end-diastolic volume index (LVEDVI) (from 189+/-74 to 132+/-41 mL/m2), and left ventricular diastolic dimension (LVDd) (from 73+/-8 to 65+/-6 mm) (p<0.001). The overall preoperative MVCD (mm) and tenting area (cm2) was 10.4+/-2.8 and 2.4+/-0.6, respectively, which were both significantly reduced to 5.6+/-2.5 and 0.8+/-2.4 postoperatively (p<0.001). In comparison of the degree (%change) of improvement, Group II and III showed favorable effects on tethering force, compared with Group I.


CONCLUSIONS
Our modified PMA is a relatively safe method to have the potential for improving tethering of the mitral valve and clinical outcome in evaluating mitral coaptation zone.
Matsui
Yoshiro
Y
Department of Cardiovascular Surgery, Ikegami General Hospital Heart Center, Tokyo, Japan.
Suto
Yukio
Y
Shimura
Shinichiro
S
Fukada
Yasuhisa
Y
Naito
Yuji
Y
Yasuda
Keishu
K
Sasaki
Shigeyuki
S
D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D010210:Papillary Muscles / Q000601:surgery*; D014463:Ultrasonography