Papillary Muscle Heads Focalization for Functional Mitral Regurgitation with Severe Tethering

Abstract

We performed “Papillary muscle heads focalization” for three patients with severe functional mitral regurgitation with severe leaflet tethering (coaptation distance ≥1 cm and/or posterior leaflet angle ≥45 degrees). All separated papillary muscle heads were sutured together and both the anterolateral and posteromedial papillary muscles were reconstructed as single head papillary muscles. The stitches are positioned to adjust the levels of mitral leaflet tips, concerning the length of the marginal chordae connected to each head. A downsized annuloplasty is performed concomitantly. At discharge, no patient showed moderate/severe mitral regurgitation. Their coaptation lengths were 7.1, 8.5, and 8.3 mm.

Keywords

cardiac - cardiomyopathy - heart valve surgery - heart failure - mitral valve surgery - myocardial remodeling

Publication History

Received: 04 October 2020

Accepted: 23 November 2020

Article published online:
08 April 2021

• References

• 1 Kuwahara E, Otsuji Y, Iguro Y. et al. Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase after surgical annuloplasty: importance of augmented posterior leaflet tethering. Circulation 2006; 114 (1, Suppl): I529-I534
• 2 Hata M, Fujita B, Hakim-Meibodi K, Gummert JF. Papillary muscle heads focalization for functional mitral valve regurgitation. Ann Thorac Surg 2020; 110 (01) e59-e61
• 3 Lancellotti P, Tribouilloy C, Hagendorff A. et al; Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013; 14 (07) 611-644
• 4 Ishikawa S, Ueda K, Kawasaki A. et al. Original papillary muscle sandwich plasty for ischemic mitral regurgitation. Circ J 2009; 73 (07) 1240-1242