title: [Surgical treatment for ischemic mitral regurgitation].
abstract: BACKGROUND
  Ischemic mitral regurgitation (IMR) is characterized by annular dilation and restricted leaflet closure with increased leaflet tethering caused by displaced attachment of the papillary muscles. Our surgical strategy for IMR consists of mitral annuloplasty (MAP) and additional left ventricular restoration procedures as needed. When the left ventricular dilation and mitral tethering are mild, we perform MAP alone. On the other hand, we add papillary muscle approximation (PMA) through left ventriculotomy with or without infero-posteiror wall exclusion (the Batista procedure) when left ventricular dilatation and leaflet tethering are severe.
  
  
  METHODS
  From November 2007 to April 2011, we surgically treated 19 patients with IMR at our institution. Of those, 13 patients underwent MAP alone (group M) and 6 patients underwent MAP and PMA (group P).
  
  
  RESULTS
  There were no hospital deaths. Postoperatively, echocardiography showed no or mild mitral regurgitation (MR) in all patients except 1 patient in group M. There was significant improvement in left ventricular ejection fraction (LVEF) in both groups. Moreover, left ventricular size decreased significantly in both groups. In group P, the tethering height, area and papillary muscle distance also decreased significantly. There were no patients who developed recurrent MR postoperatively. However, in group P, there were 2 late deaths caused by congestive heart failure and sepsis, and remaining 3 patients suffered from congestive heart failure. In group M, there were no late deaths and all patients were in New York Heart Association (NYHA) class I or II.
  
  
  CONCLUSIONS
  Our surgical strategy for IMR yields excellent reduction of MR. Especially the PMA provides promising effect on tethering reduction. However, the absence of recurrent MR was not associated with an improvement in symptoms and survival in patients who presented with severe left ventricular dilatation and leaflet tethering.
authors: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Kazuhiro
authors: K
authors: Yamazaki
authors: Kenji
authors: K
authors: Minakata
authors: Takahiro
authors: T
authors: Nakahara
authors: Masaki
authors: M
authors: Funamoto
authors: Motoyuki
authors: M
authors: Oda
authors: Fumie
authors: F
authors: Takai
authors: Takahide
authors: T
authors: Takeda
authors: Hiroyuki
authors: H
authors: Muranaka
authors: Akira
authors: A
authors: Marui
authors: Senri
authors: S
authors: Miwa
authors: Tadashi
authors: T
authors: Ikeda
authors: Ryuzo
authors: R
authors: Sakata
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D016896:Treatment Outcome