title: Correction of posteromedial papillary muscle displacement in repair of ischemic mitral regurgitation.
abstract: 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.
authors.affiliation: CJOB Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia. s.marasco@alfred.org.au
authors.forename: Silvana F
authors.initials: SF
authors.lastname: Marasco
authors.forename: Franklin L
authors.initials: FL
authors.lastname: Rosenfeldt
authors.forename: Hou-Kiat
authors.initials: HK
authors.lastname: Lim
authors.forename: Mark
authors.initials: M
authors.lastname: Mennen
authors.forename: Sesto
authors.initials: S
authors.lastname: Cairo
authors.forename: Chris
authors.initials: C
authors.lastname: Bain
mesh_terms: 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