title: Assessment of changes in mitral valve configuration with multidetector computed tomography: impact of papillary muscle imbrication and ring annuloplasty.
abstract: BACKGROUND
  The optimal surgical procedures in functional mitral regurgitation remain controversial. We applied papillary muscle imbrication (PMI) combined with undersized mitral annuloplasty (UMAP). Multidetector computed tomography (MDCT) provides images of different phases of the cardiac cycle, allowing an assessment of the geometry. In the present study, we evaluated the mitral valve configuration and subvalvular apparatus before and after UMAP and/or PMI using MDCT imaging.
  
  
  RESULTS
  We studied 26 patients with functional mitral regurgitation (3+ to 4+) with an ejection fraction ≥35% who underwent diagnostic MDCT examinations before and early after the operation. Of these, 15 underwent UMAP and PMI (UMAP+PMI group) and 11 underwent UMAP (UMAP group). The annular anteroposterior diameter, tenting height, tenting area, and interpapillary muscle distance at end-systole were quantified. The annular anteroposterior diameter, tenting height, and tenting area were significantly decreased after the operation in both groups. Whereas the average change in annular anteroposterior diameter, tenting area, and interpapillary muscle distance did not differ between the 2 groups, the average change in tenting height was greater in the UMAP+PMI group than in the UMAP group (5.1±1.3 versus 3.8±2.3 mm, P=0.036). There was a significant correlation between the change in interpapillary muscle distance and the change in tenting height in the UMAP+PMI group (r=0.788, P=0.0005).
  
  
  CONCLUSIONS
  Our results examined with MDCT indicated that UMAP combined with PMI improved leaflet tethering compared with UMAP, reflecting differences in the effects of the surgical procedures used, and suggested that concomitant PMI might be beneficial in some cases.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shudo
authors.forename: Goro
authors.initials: G
authors.lastname: Matsumiya
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Hironori
authors.initials: H
authors.lastname: Izutani
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D009200:Myocardial Contraction; D012189:Retrospective Studies; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed