Impact of Papillary Muscle Relocation as Adjunct Procedure to Mitral Ring Annuloplasty in Functional Ischemic Mitral Regurgitation

The optimal surgical treatment in functional ischemic mitral regurgitation (FIMR) remains controversial. Recently, a posterior papillary muscle relocation (PMR) technique as adjunct procedure to ring annuloplasty has been proposed to prevent recurrent FIMR. In the present study, we used 3D cardiac M...

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Published in:Circulation (New York, N.Y.) N.Y.), 2009-09, Vol.120 (11), p.S92-S98
Main Authors: JENSEN, Henrik, JENSEN, Morten O, SMERUP, Morten H, VIND-KEZUNOVIC, Stefan, RINGGAARD, Steffen, ANDERSEN, Niels T, VESTERGAARD, Rikke, WIERUP, Per, HASENKAM, J. Michael, NIELSEN, Sten L
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Blood and lymphatic vessels
Blood vessels and receptors
Cardiology. Vascular system
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Fundamental and applied biological sciences. Psychology
Medical sciences
Mitral Valve - surgery
Mitral Valve Insufficiency - pathology
Mitral Valve Insufficiency - physiopathology
Mitral Valve Insufficiency - surgery
Myocardial Ischemia - complications
Papillary Muscles - surgery
Swine
Ventricular Function, Left
Ventricular Remodeling
Vertebrates: cardiovascular system
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Summary:The optimal surgical treatment in functional ischemic mitral regurgitation (FIMR) remains controversial. Recently, a posterior papillary muscle relocation (PMR) technique as adjunct procedure to ring annuloplasty has been proposed to prevent recurrent FIMR. In the present study, we used 3D cardiac MRI to assess the impact of relocating both papillary muscles as adjunct procedure to downsized ring annuloplasty on mitral leaflet coaptation geometry in FIMR pigs. Eleven FIMR pigs were randomized to downsized ring annuloplasty (RA; n=6) or RA combined with PMR (RA+PMR, n=5). In the RA+PMR group, a 2-0 Gore-Tex suture was attached to each trigone, exteriorized through the corresponding papillary muscle, mounted on an epicardial pad, and tightened to relocate the myocardium adjacent to the anterior and posterior papillary muscles 5 and 15 mm, respectively. Using 3D MRI, the impact from these interventions on leaflet geometry was assessed. The distance from the posterior papillary muscle to the anterior trigone was reduced significantly more (median values) in the RA+PMR compared with RA animals at end-diastole (-7.9% versus 3.8%, P
ISSN:0009-7322
1524-4539
DOI:10.1161/circulationaha.108.817833