title: Impact of subvalvular procedure for ischemic mitral regurgitation on leaflet configuration, mobility, and recurrence.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. tueno@m.kufm.kagoshima-u.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ueno
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Iguro
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ueno
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ueno
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Hisashi
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: 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