The 'down-under repair' for ischaemic mitral regurgitation.
Current surgical management of restrictive ischaemic mitral regurgitation (IMR) includes mitral valve annuloplasty (MVA) using an undersized ring when the mechanism is secondary to leaflet restriction. In our experience, MVA alone is inadequate to eliminate mitral incompetence in these patients. We report the 'Down-Under Repair' as an adjunctive concept for the treatment of a subset of patients with restrictive IMR and associated inferobasal left ventricular aneurysm. The 'Down-Under Repair' reduces mitral leaflet restriction by approximating the origin of the posterior papillary muscle towards the mitral annulus. Midterm results demonstrated sustained valvular competence and symptomatic improvement.
Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Siew
S
Goh
Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Andrew
A
Newcomb
Cardiology Department, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
David
D
Prior
Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Alexander
A
Rosalion
Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Ian
I
Nixon
Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Philip
P
Davis
Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia. Electronic address: michael.yii@svhm.org.au.
Michael
M
Yii
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies
Cardiac aneurysm; Ischaemic heart disease; Mitral regurgitation; Mitral valve annuloplasty; Myocardial infarction