Papillary muscle realignment and mitral annuloplasty in patients with severe ischemic mitral regurgitation and dilated heart

Abstract

Chronic ischemic mitral regurgitation (IMR) is one of the leading causes of congestive heart failure and death. It is controversial whether mitral annuloplasty (MAP) per se can improve the long-term survival because IMR has been considered a disease of the left ventricle. We reviewed our experience of papillary muscle realignment in conjunction with MAP in patients with IMR. Between September 2004 and October 2007, seven patients were treated with papillary muscle realignment and MAP with coronary bypass grafting. The mean age was 60.3+/-3.5 years. The mean number of distal anastomoses was 3.6+/-1.9. Procedural success without in-hospital complications was achieved in all cases, except one patient who had a stroke and another patient with prolonged ventilation. Echocardiographic examination revealed that postoperative coaptation depth (10.2+/-3.1 mm preoperatively vs. 6.5+/-2.0 mm postoperatively), tenting area (1.8+/-0.8 cm(2) vs. 0.6+/-0.1 cm(2)), end-diastolic interpapillary muscle distance (36.4+/-4.7 mm vs. 27.1+/-4.6 mm) and the grade of MR (3.3+/-0.5 vs. 0.4+/-0.5) significantly improved. Furthermore, a six-month echocardiographic examination demonstrated that these improvements remained unchanged. The combination of papillary muscle realignment and MAP seems to be effective in patients with IMR. The duration of the effect may be expected to be long-term with these methods.