title: Ring-Noose-String Technique Allows Adjustable Papillary Muscle Repositioning During Minimally Invasive Mitral Valve Repair in Patients with Functional/Ischemic Mitral Regurgitation.
abstract: In patients with functional/ischemic mitral regurgitation (FMR/IMR), mitral annuloplasty alone frequently results in recurrent regurgitation because of ongoing left ventricular dilatation and recurrent leaflet tethering. Adjunctive subvalvular approaches exist, but the technical shortcomings limit their clinical acceptance. A novel adjunctive technique was applied in three patients: A polytetrafluoroethylene string and noose were anchored to the posteromedial and anterolateral papillary muscle, respectively. The string ends were guided through the noose, exteriorized through the midposterior annulus into the left atrium, and length-adjusted during the saline test. The procedure allowed safe and straightforward papillary muscle repositioning and may stabilize repair results in FMR/IMR patients.
authors: Department of Cardiovascular Surgery, Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.
authors: Wolfgang
authors: W
authors: Bothe
authors: Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
authors: Torsten
authors: T
authors: Doenst
mesh_terms: D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011138:Polytetrafluoroethylene; D020127:Recovery of Function; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation; D013537:Sutures; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene