Impact of subvalvular procedure for ischemic mitral regurgitation on leaflet configuration, mobility, and recurrence.
BACKGROUND
Procedures on the subvalvular apparatus are an etiology-based treatment for ischemic mitral regurgitation (IMR).


RESULTS
Fifty-nine patients with IMR were divided into 3 groups: mitral annuloplasty (MAP) (M group, n=27), MAP+left ventricular reconstruction (LVR) (LV group, n=18), and MAP+LVR+subvalvular procedure (S group, n=14). Tenting height and area, angle between the annular line and the line connecting leaflet base to the bending- or tip-point of either the anterior or posterior leaflet, and leaflet mobility were measured echocardiographically preoperatively and at immediate- and mid-term postoperative follow-up. The angles at the bending-point of the anterior leaflet in mid-systole remained greater than those at its tip-point in the M and LV groups, but became significantly smaller postoperatively only in the S group (p<0.05). Postoperative leaflet mobility at the bending-point in the S group became significantly greater than in the other groups (p<0.01). The grade of MR, after significant reduction by the procedure, increased again in the M and LV groups, but remained almost unchanged in the S group.


CONCLUSIONS
Subvalvular procedures improved the configuration and mobility of the anterior leaflet, and can be expected to reduce the recurrence of IMR.
Ueno
Tetsuya
T
Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. tueno@m.kufm.kagoshima-u.ac.jp
Sakata
Ryuzo
R
Iguro
Yoshifumi
Y
Yamamoto
Hiroyuki
H
Ueno
Masahiro
M
Ueno
Takayuki
T
Matsumoto
Kazuhisa
K
Hisashi
Yousuke
Y
Tei
Chuwa
C
D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence