title: Posterior leaflet segment 2 plication in ischemic mitral regurgitation repair.
abstract: OBJECTIVE
  To evaluate the medium-term results of plication of posterior leaflet segment 2 in addition to ring annuloplasty in patients with functional ischemic mitral regurgitation.
  
  
  METHODS
  The study included 136 patients who underwent mitral valve repair with plication of posterior leaflet segment 2 for ischemic mitral regurgitation between 2004 and 2012. The direction and correlation of left ventricle sphericity and tethering area were established by Pearson correlation analysis in patients with or without recurrent mitral regurgitation in the medium term.
  
  
  RESULTS
  Medium-term survival was 91.9% and freedom from moderate or severe mitral regurgitation was 89.6%. In medium-term follow-up, transthoracic echocardiography found a significant decrease in tethering area, coaptation height, and distance between the commissures compared to the pre-surgery values (p = 0.0001 in all). The distance between the papillary muscles was reduced compared to the pre-surgery period but it was not significant (p = 0.204). Pearson correlation analysis found no significant correlation between the tethering area and left ventricle sphericity in patients without recurrent mitral regurgitation (r = 0.15, p = 0.36), a highly positive correlation (r = 0.44, p < 0.001) in patients with mild recurrent mitral regurgitation, and a moderately positive correlation (r = 0.71, p < 0.01) in patients with moderate or severe recurrent mitral regurgitation.
  
  
  CONCLUSIONS
  The tethering area, coaptation height, and distance between the commissures decreased significantly, thus posterior leaflet segment 2 plication in addition to ring annuloplasty may be the optional procedure to ensure freedom from moderate or severe mitral regurgitation.
authors.affiliation: Department of Cardiovascular Surgery, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Ay
authors.affiliation: Department of Cardiovascular Surgery, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Erkin
authors.affiliation: Department of Cardiovascular Surgery, Sakarya University School of Medicine, Sakarya, Turkey ikara7881@hotmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kara
authors.affiliation: Department of Cardiovascular Surgery, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Aydin
authors.affiliation: Department of Cardiology, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: Nuray Kahraman
authors.initials: NK
authors.lastname: Ay
authors.affiliation: Department of Cardiovascular Surgery, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: Rahmi
authors.initials: R
authors.lastname: Zeybek
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology; D012008:Recurrence; D012307:Risk Factors; D020257:Ventricular Remodeling
keywords: Cardiac surgical procedures; Coronary artery bypass; Mitral valve annuloplasty; Mitral valve insufficiency; Myocardial ischemia; Ventricular remodeling