Correction of posteromedial papillary muscle displacement in repair of ischemic mitral regurgitation.
OBJECTIVE
Ischemic mitral regurgitation is present in a substantial proportion of patients presenting for coronary revascularization. Although patients with even mild to moderate ischemic mitral regurgitation (IMR) have a poorer long-term outcome, mitral valve repair in these cases can be unreliable due to the posterior leaflet tethering that commonly occurs. The aim of this animal-based study was to evaluate a novel technique to effect such a repair.


METHODS
IMR was produced in six greyhound dogs by tying off the circumflex coronary artery; a mitral valve repair was then performed on cardiopulmonary bypass (CPB). Two hitching sutures from the posteromedial papillary muscle (PPM) to the annulus were individually assessed using epicardial echocardiography when the dogs had been weaned off CPB.


RESULTS
Acute dilatation of the heart with PPM displacement and mitral regurgitation were produced in this acute infarct model. Both hitching sutures shortened the distance from the free edge of the posterior leaflet to the PPM tip and reduced its displacement, with a resultant reduction in mitral regurgitation.


CONCLUSIONS
This simple repair technique may be a useful adjunct to annuloplasty in the treatment of ischemic mitral regurgitation.
Marasco
Silvana F
SF
CJOB Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia. s.marasco@alfred.org.au
Rosenfeldt
Franklin L
FL
Lim
Hou-Kiat
HK
Mennen
Mark
M
Cairo
Sesto
S
Bain
Chris
C
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods; D004195:Disease Models, Animal; D004285:Dogs; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D017202:Myocardial Ischemia / Q000601:surgery*; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D013536:Suture Techniques; D014463:Ultrasonography